Background: Cisplatin (CDDP) and 5-fluorouracil (5-FU) are used in first-line chemotherapy for recurrent esophageal squamous cell carcinoma (ESCC) after radical esophagectomy; however, patients have a poor prognosis after failure of first-line treatment. We herein report the achievement of long-term survival after proton therapy in an ESCC patient in whom the first-line chemotherapy failed.
Case presentation: A 60-year-old man was diagnosed as having squamous cell carcinoma of the lower thoracic esophagus (cT2N0M0, Stage IIA). He underwent two courses of neoadjuvant chemotherapy with CDDP and 5-FU, and esophagectomy with three-field lymphadenectomy was performed. Microscopic findings after resection showed two lymph node metastases (ypT2N1M0, Stage IIB). Five months after surgery, a computed tomography scan revealed a solitary liver metastasis in the S4 area. He underwent three courses of chemotherapy with CDDP and 5-FU. Although surgeons decided to perform resection for the liver metastasis, preoperative positron emission tomography (PET) revealed two lymph node metastases. Surgeons recommended second-line chemotherapy or chemoradiotherapy, bud the patient refused second-line chemotherapy and requested proton beam therapy (PBT). We performed PBT without chemotherapy for the liver metastasis and lymph node metastases with total dose of 79.2 and 60Gy relative biological effectiveness, respectively, according to the tumor location. The PBT resulted in a complete response as shown by PET. An acute side effect of grade 1 dermatitis occurred after PBT, but there was no acute or late complication of more than grade 2. The patient remains in complete remission 5 years after treatment without surgery or chemotherapy.
Conclusions: PBT exerted a curative effect on postoperative recurrence of ESCC. This is the first report about PBT for postoperative ESCC with liver and lymph node metastases after failure of first-line chemotherapy for metastases in distant organs.