Abstract
A 50-year-old woman was diagnosed with unresectable advanced middle thoracic esophageal cancer with lymph node metastases involving the trachea in July 2008. After definitive chemoradiotherapy (dCRT) with cisplatin (CDDP) / 5-fluorouracil (5-FU) and 60 Gy irradiation and additional 2 courses of CDDP / 5-FU were performed, complete response (CR) was obtained. Around half year after the treatment, positron emission tomography-computed tomography showed para-aortic lymph node (PAN) and supraclavicular lymph node (SCN) metastases. Five courses of CDDP / 5-FU and 3 courses of 5-FU / nedaplatin (CDGP) were performed. CR was achieved for PAN but not for SCN, which was judged as stable disease (SD). Since no other lesions were identified, she underwent salvage lymphadenectomy in July 2010. Seven months after the operation, paraesophageal and peri-gastric lymph nodes metastases were detected. After 5 courses of 5-FU / CDGP, the metastatic lymph nodes disappeared. However, relapse of paraesophageal lymph node metastasis and secondary primary esophageal cancer at 23 cm from the incisor teeth developed in February 2012. As R0 resection could be expected, salvage esophagectomy by laparotomy-right thoracotomy approach was performed in March 2012. The patient is now alive without recurrence for 3 years and 7 months after the salvage esophagectomy (or 7 years and 3 months after dCRT).
