A Case of Recurrence of Esophageal Cancer to the Posterior Thoracic Paraaortic Lymph Node after Esophagectomy in which Multimodal Therapy Led to a Long-term (54 Months) Survival

Abstract

A 72-year-old woman who presented with difficulty in oral ingestion was diagnosed with cancer of the lower thoracic esophagus <UICC7th-cT3N3M1(#104R), cStage IV>. We performed 2 courses of 5-fluorouracil + cisplatin (FP therapy) as neoadjuvant chemotherapy, followed by esophagectomy via right thoracotomy and three-field lymph node dissection. Histopathology revealed UICC 7^th-pT3N2M1(#104R) pStage IV, that appeared to suggest a high risk of recurrence. Consequently, additional radiation therapy (60 Gy) targetting #104R and #101R was conducted. PET-CT scan performed 7 months after the operation showed abnormally high accumulation of FDG to the posterior thoracic paraaortic lymph node. Recurrence of the esophageal cancer was considered, and we performed chemoradiation therapy (60 Gy + 2 courses of FP therapy). Thereafter 2 courses of weekly paclitaxel therapy were added. The patient has been free from any recurrence as of 61 months after the operation.

It is difficult to make therapeutic guidelines for recurrence to the posterior thoracic paraaortic lymph node after radical surgery for esophageal cancer. In treating this patient, we once considered to perform surgical resection, but our selection to employ multimodal therapy resulted in long-term survival. It might be beneficial for the treatment that the recurrence had involved a solitary lymph node.