Salvage Esophagectomy after Photodynamic Therapy for Secondary Squamous Cell Carcinoma in a Patient with a History of Complete Response to Chemoradiotherapy for Unresectable Advanced Esophageal Neuroendocrine Carcinoma

Abstract

Esophageal neuroendocrine carcinoma (NEC) is a relatively rare esophageal malignancy with high histological grade and poor prognosis. Chemotherapy with or without radiation is recommended because NEC is often detected at an advanced stage and the recurrence rate is relatively high. For esophageal cancer, photodynamic therapy (PDT) is indicated after chemoradiotherapy (CRT), and salvage surgery is rarely performed afterwards. We report here a case in which PDT and salvage surgery were performed for secondary esophageal squamous cell carcinoma after esophageal NEC showed complete response to CRT. Eighteen months before this presentation, a 71-year-old woman underwent CRT for esophageal NEC (cT4b (trachea) N2M0 Stage IV) and no residual lesion was detected. Upper gastrointestinal endoscopy revealed multiple superficial-type squamous cell carcinomas in the esophagus at 25, 26, and 38 cm from the incisors. The lesion 38 cm from the incisors had invaded to the submucosal layer and the others represented in situ carcinomas. PDT was performed twice for all lesions, but residual tumor remained at 38 cm from the incisors. Ivor Lewis esophagectomy was performed because the earlier NEC had invaded to the trachea before CRT. Intraoperative findings included edema and scarring of the esophageal wall. The postoperative course was good and the patient was discharged on postoperative day 23.