From:  Oligometastatic esophageal cancer cured by systemic therapy combined with radiotherapy to primary tumor and metastasis (metastasis-directed therapy)—small case series

 Table outlining the clinical summary of Cases (1–4), clinical presentation, diagnosis and staging, treatment, follow-up and present status

Patient factorsCase 1Case 2Case 3Case 4
Demographics49 years/Male68 years/Male53 years/Male68 years/Male
Clinical presentationFeb 2011
Dysphagia, weight loss		Feb 2013
Dysphagia		Feb 2010
Dysphagia		June 2015
Dysphagia
WHO performance status (PS)
Comorbidities		PS0
No significant PMH		PS0
No significant PMH		PS0
No significant PMH		PS0
Type II DM, hypertension
Investigations

  • OGD—tumor 34–38 cm

  • PET/CT—multiple loco-regional nodes, upper para-aortic lymphadenopathy, lung nodules

  • OGD—tumor 40–46 cm

  • PET/CT—loco-regional gastro-hepatic node, para-aortic lymphadenopathy

  • OGD—tumor 35–40 cm (non-traversable)

  • PET/CT—avid high left para-tracheal LN and T9 vertebral metastasis

  • OGD—tumor 28–35 cm

  • EUS—high para-esophageal LN

  • PET—avid high paraesophageal LN (outside surgical resection field)

Diagnosis staging

  • Intestinal type moderately differentiated AC

  • Final staging T3N3M1

  • AC

  • Final staging T3N1M1

  • AC

  • Final staging T3N1M1

  • Squamous cell carcinoma (SqCC)

  • T3N0M1 (non-regional LN)

Treatment

  • Apr 2011–Sep 2011—completed 6 cycles EOX

  • Oct 2011—consolidation RT to primary tumor and adjacent nodal disease (gastro-hepatic): 30 Gy in 10 fractions

  • Jun 2013–Nov 2013—cycles cisplatin/capecitabine and trastuzumab

  • Dec 2013—Consolidation RT adjacent nodal disease (gastro-hepatic and para-aortic): 30 Gy in 10 fractions

  • Nov 2013–Apr 2017—maintenance trastuzumab

  • Feb 2010–Jul 2010—6 cycles EOX

  • Aug 2010—Consolidation RT to primary tumor and adjacent area of metastatic disease (T9 vertebrae): 30 Gy in 10 fractions

  • Sep 2015–Dec 2015—5 cycles EOX chemotherapy

  • Feb 2016—consolidation RT primary tumor and nodal disease: 30 Gy in 10 fractions

Follow-up

  • 3–6 monthly interval CT scans

  • Jun 2017—PET/CT and OGD

  • 3–6 monthly interval CT scans

  • Jul 2017—PET/CT and OGD

  • 3–6 monthly interval CT scans

  • Dec 2018—PET/CT

  • 3–6 monthly interval CT scans

Present status (Mar 2023)

  • Alive and well

  • No evidence of recurrence

  • Alive and well

  • No evidence of recurrence

  • Alive and well

  • No evidence of recurrence

  • Alive and well

  • No evidence of recurrence

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PMH: past medical history; DM: diabetes mellitus; EOX: epirubicin, oxaliplatin, and capecitabine; OGD: oral gastroduodenoscopy; EUS: endoscopic ultrasound; CT: computed tomography; PET: positron emission tomography; LN: lymph node; AC: adenocarcinoma