A Case Report Successful Treatment the Patient with Squamous Esophagus Cancer IV Stage

   In this study, we described a clinical case of unoperable squamous carcinoma in the thoracic esophagus, demonstrating the effectiveness of induction chemotherapy followed by independent chemoradiotherapy and brachytherapy in patients with metastatic esophageal carcinoma. The patient was treated with induction chemotherapy, concurrent chemoradiation with weekly carboplatin AUC 2 and paclitaxel 50 mg/m² and brachytherapy. The most characteristic feature of this clinical case is that the use of brachytherapy in the complex treatment of patients with esophageal carcinoma allows increasing the dose in the target without increasing the risk of complications associated with the escalation of the radiation dose. Brachytherapy can achieve very high rates of local control with a reduction in morbidity, compared with external beam radiation therapy. In most patients, esophageal carcinoma is diagnosed at stages III–IV of the disease. Squamous cell esophageal carcinoma is an aggressive disease that, depending on the prevalence, requires various treatment methods, the search for the optimal one is still ongoing. The main standard of treatment in inoperable patients with squamous cell esophageal carcinoma is self — chemoradiotherapy. However, in patients with unoperable esophageal carcinoma, it is also possible to use induction chemotherapy followed by independent chemoradiotherapy and brachytherapy. The combined use of these methods of treatment in conditions of impossibility of surgical intervention is the method of choice in patients with stage III–IV of the disease. The standard dose of DLT for squamous carcinoma of the esophagus is 50.4 Gy. In the conducted studies, it was shown that the escalation of the dose to the tumor using remote radiation therapy leads to an increase in severe post-radiation injuries and an increase in the frequency of deaths. Induction chemotherapy plus concurrent chemoradiotherapy and brachytherapy to boost tumor, and improves disease control and survival.

1. Jamal A., Homa D. M., O’Connor E., et al. Current cigarette smoking among adults — United States, 2005-2014. MMWR Morb Mortal Wkly Rep. 2015; 64 (44): 1233-40. DOI: 10.15585/mmwr.mm6444a2

2. Abnet C. C., Arnold M., Wei W. Q. Epidemiology of esophageal squamous cell carcinoma Gastroenterology. 2018; 154 (2): 360-73. DOI: 10.1053/j.gastro.2017.08.023

3. Ferlay J., Shin H. R., Bray F., Forman D., Mathers C., Parkin D. M. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010 Dec 15; 127 (12): 2893-917. DOI: 10.1002/ijc.25516.

4. Каприн А. Д. Состояние онкологической помощи населению России в 2018 году / А. Д. Каприн, В. В. Старинский, Г. В. Петрова. − М.: МНИОИ им. П. А. Герцена — филиал ФГБУ «НМИЦ радиологии» Минздрава России, 2019. – 236 с. [Kaprin A. D., Starinsky V. V., Petrova G. V. The state of oncological care to the population of Russia in 2018, Moscow, 2019. 236 p. (In Russian)].

5. Then E. O., Lopez M., Saleem S., et al. Esophageal Cancer: An Updated Surveillance Epidemiology and End Results Database Analysis. World J Oncol. 2020 Apr; 11 (2): 55-64. DOI: 10.14740/wjon1254.

6. Horie Y., Yoshio T., Aoyama K., et al. Diagnostic outcomes of esophageal cancer by artificial intelligence using convolutional neural networks. Gastrointest Endosc. 2019 Jan; 89 (1): 25-32. DOI: 10.1016/j.gie.2018.07.037.

7. Cooper J. S., Guo M. D., Herskovic A., et al. Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA. 1999 May 5; 281 (17): 1623-7. DOI: 10.1001/jama.281.17.1623.

8. Minsky B. D., Pajak T. F., Ginsberg R. G., et al. INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol. 2002 Mar 1; 20 (5): 1167-74. DOI: 10.1200/JCO.2002.20.5.1167.

9. de Vos-Geelen J., Hoebers F. J. P., Geurts S. M. E., et al. A national study to assess outcomes of definitive chemoradiation regimens in proximal esophageal cancer. Acta Oncol. 2020 Aug; 59 (8): 895-903. DOI: 10.1080/0284186X.2020.1753889.

10. Maarten C. C. Mю, Hulshof E. D., et al. Randomized Study on Dose Escalation in Definitive Chemoradiation for Patients with Locally Advanced Esophageal Cancer (ARTDECO Study). J Clin Oncol, 2021 Sep 1; 39 (25): 2816-24. DOI: 10.1200/JCO.20.03697.