Successful multidisciplinary treatment including repeated metastasectomy for recurrent squamous cell esophageal carcinoma: a case report

Abstract Background Recurrences after radical esophagectomy are common. The prognosis for recurrent esophageal cancer is generally poor. Recurrences usually occur between 1 and 3 years of surgery, with the duration of median survival after recurrence ranging from 5 to 10 months. The number of sites...

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Main Authors: Kosuke Hirose, Hiroshi Saeki, Yuichiro Nakashima, Tomohiro Kamori, Yoshiaki Fujimoto, Tetsuro Kawazoe, Hiroya Matsuoka, Yasuhiro Haruta, Shun Sasaki, Tomoko Jogo, Qingjiang Hu, Yasuo Tsuda, Koji Ando, Eiji Oki, Ryuzo Hiratsuka, Yoshinao Oda, Masaki Mori
Format: Article
Language:English
Published: Japan Surgical Society 2019-05-01
Series:Surgical Case Reports
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Online Access:http://link.springer.com/article/10.1186/s40792-019-0634-5
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author Kosuke Hirose
Hiroshi Saeki
Yuichiro Nakashima
Tomohiro Kamori
Yoshiaki Fujimoto
Tetsuro Kawazoe
Hiroya Matsuoka
Yasuhiro Haruta
Shun Sasaki
Tomoko Jogo
Qingjiang Hu
Yasuo Tsuda
Koji Ando
Eiji Oki
Ryuzo Hiratsuka
Yoshinao Oda
Masaki Mori
author_facet Kosuke Hirose
Hiroshi Saeki
Yuichiro Nakashima
Tomohiro Kamori
Yoshiaki Fujimoto
Tetsuro Kawazoe
Hiroya Matsuoka
Yasuhiro Haruta
Shun Sasaki
Tomoko Jogo
Qingjiang Hu
Yasuo Tsuda
Koji Ando
Eiji Oki
Ryuzo Hiratsuka
Yoshinao Oda
Masaki Mori
author_sort Kosuke Hirose
collection DOAJ
description Abstract Background Recurrences after radical esophagectomy are common. The prognosis for recurrent esophageal cancer is generally poor. Recurrences usually occur between 1 and 3 years of surgery, with the duration of median survival after recurrence ranging from 5 to 10 months. The number of sites and involved organs vary among patients. Consequently, a standard therapeutic strategy has not been established, and the role of surgery in the management of recurrence is unclear. Case presentation A 67-year-old man presented with dysphagia 6 months previously and was diagnosed with esophageal squamous cell carcinoma (ESCC) in the upper thoracic region (T2M0M0, stage IB), for which he underwent thoracoscopy-assisted esophagectomy and lymphadenectomy. Adjuvant chemotherapy was not prescribed. Three years after the operation, he developed a solitary metastasis in the left lung, requiring segmentectomy followed by chemotherapy with combined cisplatin (CDDP) and 5-fluorouracil (5-FU). The following year, a metastatic lesion was recognized in the right lung, invading the chest wall, for which he underwent partial lobectomy with local chest wall resection. Multiple mediastinal and abdominal lymph node (LN) metastases were detected in the right lung a year later, which necessitated chemoradiation to a dose of 50.4 Gy with concomitant CDDP and 5-FU. Post-treatment computed tomography (CT) showed a good response. Positron emission tomography (PET)-CT revealed a reduction in the metastatic LNs with no fluoro-deoxy-glucose (FDG) uptake. The following year, metastases were detected in the left cervical LNs. Owing to the limited extent of metastases, resection was followed by chemoradiation to a dose of 50 Gy with CDDP and 5-FU. The following year, metastases were detected in the mediastinal LNs; chemotherapy was administered with nedaplatin and docetaxel. The follow-up CT and PET-CT demonstrated complete disappearance of the tumor, and the patient is currently surviving without recurrence for 11 years from the first curative operation. Conclusions This case demonstrates that aggressive multidisciplinary treatment including surgery and radiation to achieve local control could be a meaningful treatment strategy in cases with limited and slowly occurring recurrences.
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spelling doaj-art-8aba679456144fcb97e0e06637c1adcf2025-08-20T03:35:23ZengJapan Surgical SocietySurgical Case Reports2198-77932019-05-01511810.1186/s40792-019-0634-5Successful multidisciplinary treatment including repeated metastasectomy for recurrent squamous cell esophageal carcinoma: a case reportKosuke Hirose0Hiroshi Saeki1Yuichiro Nakashima2Tomohiro Kamori3Yoshiaki Fujimoto4Tetsuro Kawazoe5Hiroya Matsuoka6Yasuhiro Haruta7Shun Sasaki8Tomoko Jogo9Qingjiang Hu10Yasuo Tsuda11Koji Ando12Eiji Oki13Ryuzo Hiratsuka14Yoshinao Oda15Masaki Mori16Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityHiratsuka Gastrointestinal Surgical ClinicDepartment of Anatomic Pathology and Pathological Sciences, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityAbstract Background Recurrences after radical esophagectomy are common. The prognosis for recurrent esophageal cancer is generally poor. Recurrences usually occur between 1 and 3 years of surgery, with the duration of median survival after recurrence ranging from 5 to 10 months. The number of sites and involved organs vary among patients. Consequently, a standard therapeutic strategy has not been established, and the role of surgery in the management of recurrence is unclear. Case presentation A 67-year-old man presented with dysphagia 6 months previously and was diagnosed with esophageal squamous cell carcinoma (ESCC) in the upper thoracic region (T2M0M0, stage IB), for which he underwent thoracoscopy-assisted esophagectomy and lymphadenectomy. Adjuvant chemotherapy was not prescribed. Three years after the operation, he developed a solitary metastasis in the left lung, requiring segmentectomy followed by chemotherapy with combined cisplatin (CDDP) and 5-fluorouracil (5-FU). The following year, a metastatic lesion was recognized in the right lung, invading the chest wall, for which he underwent partial lobectomy with local chest wall resection. Multiple mediastinal and abdominal lymph node (LN) metastases were detected in the right lung a year later, which necessitated chemoradiation to a dose of 50.4 Gy with concomitant CDDP and 5-FU. Post-treatment computed tomography (CT) showed a good response. Positron emission tomography (PET)-CT revealed a reduction in the metastatic LNs with no fluoro-deoxy-glucose (FDG) uptake. The following year, metastases were detected in the left cervical LNs. Owing to the limited extent of metastases, resection was followed by chemoradiation to a dose of 50 Gy with CDDP and 5-FU. The following year, metastases were detected in the mediastinal LNs; chemotherapy was administered with nedaplatin and docetaxel. The follow-up CT and PET-CT demonstrated complete disappearance of the tumor, and the patient is currently surviving without recurrence for 11 years from the first curative operation. Conclusions This case demonstrates that aggressive multidisciplinary treatment including surgery and radiation to achieve local control could be a meaningful treatment strategy in cases with limited and slowly occurring recurrences.http://link.springer.com/article/10.1186/s40792-019-0634-5Esophageal cancerRecurrenceLong survivalMultidisciplinary treatment
spellingShingle Kosuke Hirose
Hiroshi Saeki
Yuichiro Nakashima
Tomohiro Kamori
Yoshiaki Fujimoto
Tetsuro Kawazoe
Hiroya Matsuoka
Yasuhiro Haruta
Shun Sasaki
Tomoko Jogo
Qingjiang Hu
Yasuo Tsuda
Koji Ando
Eiji Oki
Ryuzo Hiratsuka
Yoshinao Oda
Masaki Mori
Successful multidisciplinary treatment including repeated metastasectomy for recurrent squamous cell esophageal carcinoma: a case report
Surgical Case Reports
Esophageal cancer
Recurrence
Long survival
Multidisciplinary treatment
title Successful multidisciplinary treatment including repeated metastasectomy for recurrent squamous cell esophageal carcinoma: a case report
title_full Successful multidisciplinary treatment including repeated metastasectomy for recurrent squamous cell esophageal carcinoma: a case report
title_fullStr Successful multidisciplinary treatment including repeated metastasectomy for recurrent squamous cell esophageal carcinoma: a case report
title_full_unstemmed Successful multidisciplinary treatment including repeated metastasectomy for recurrent squamous cell esophageal carcinoma: a case report
title_short Successful multidisciplinary treatment including repeated metastasectomy for recurrent squamous cell esophageal carcinoma: a case report
title_sort successful multidisciplinary treatment including repeated metastasectomy for recurrent squamous cell esophageal carcinoma a case report
topic Esophageal cancer
Recurrence
Long survival
Multidisciplinary treatment
url http://link.springer.com/article/10.1186/s40792-019-0634-5
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