[A case of residual metastatic lymph node lesion following definitive chemoradiotherapy for T4 esophageal cancer, successfully treated by outpatient clinic-based sequential chemotherapy with docetaxel followed by S-1].
Patients with T4 esophageal cancer generally have poor prognosis. Of these patients, prognosis of non-responder to chemoradiothrapy (CRT) is extremely poor. We report a case of residual lymph node metastasis following definitive CRT, which showed a good response to outpatient clinic-based chemotherapy consisting of docetaxel (DOC) followed by S-1 in a patient with T4 esophageal cancer. The patient was a 65-year-old man with the diagnosis of squamous cell carcinoma of the middle thoracic esophagus with the 5 cm size lymph node metastasis with tracheal invasion along right recurrent laryngeal nerve [T4 (106recR-rt subclavian A) N2M0, Stage IVa]. He underwent induction chemotherapy with two courses of FP followed by one course of DCF. As a result, primary tumor was judged as complete response on endoscopy, and the lymph node lesion was judged as partial response, but unresectable on CT. Then, he underwent definitive CRT (FP+60 Gy). Following CRT, although the lymph node lesion was judged as non-CR on CT, a significant decrease of FDG uptake (PET-CR) was observed on PET-CT. Five months later, a recurrence of the lymph node lesion was observed on PET-CT. Then, he underwent outpatient clinic-based chemotherapy with DOC( 60 mg/m², triweekly) followed by S-1( 80 mg/ body/day, 6 weeks/course, administration for 4 weeks with 2 weeks cessation). DOC was administered for 8 months, and was converted to S-1 because of the regrowth of the lesion on PET-CT. After 3 months following initiation of S-1, a remarkable decrease of the lesion was observed on PET-CT. During outpatient clinic observation, the residual lymph node lesion after definitive CRT was well controlled over 1 year, and no new metastatic lesions were observed at other sites. Sequential chemotherapy with DOC followed by S-1 may be effective in controlling progression of resistant tumor against prior CRT.
Division of Digestive Surgery, Dept. of Surgery, Kyoto Prefectural University of Medicine.
Masayuki
M
Yoneda
Hitoshi
H
Fujiwara
Atsushi
A
Shiozaki
Shuhei
S
Komatsu
Daisuke
D
Ichikawa
Kazuma
K
Okamoto
Yasutoshi
Y
Murayama
Yoshiaki
Y
Kuriu
Hisashi
H
Ikoma
Masayoshi
M
Nakanishi
Toshiya
T
Ochiai
Yukihito
Y
Kokuba
Eigo
E
Otsuji
D000368:Aged; D000554:Ambulatory Care Facilities; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D000077143:Docetaxel; D004338:Drug Combinations; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D017809:Fatal Outcome; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D010094:Oxonic Acid / Q000627:therapeutic use*; D043823:Taxoids / Q000627:therapeutic use*; D005641:Tegafur / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents; D004338:Drug Combinations; D043823:Taxoids; C079198:S 1 (combination); D005641:Tegafur; D000077143:Docetaxel; D010094:Oxonic Acid