Korean J Gastroenterol.  2012 Aug;60(2):113-118. 10.4166/kjg.2012.60.2.113.

A Case of Synchronous Esophagus and Stomach Cancer Successfully Treated by Combined Chemotherapy

• Han JS
• Choi SR
• Jang JS
• Roh MH
• Kim DC
• Ryu SH
• Woo SM
• Hsing CT

• KMID: 1387340
• DOI: http://doi.org/10.4166/kjg.2012.60.2.113

Abstract

Although cases of simultaneous esophagus and stomach cancer have been reported sporadically, there are rare reports of successful treatment using chemotherapy. We report a case of synchronous esophageal and gastric cancer successfully treated using docetaxel and cis-diammineedichloro-platinum (CDDP) combination chemotherapy instead of surgery. A 82-years-old man with anorexia and progressive weight loss was diagnosed with synchronous esophageal and gastric cancer by endoscopy. Both cancers were diagnosed as resectable by the preoperative clinical staging. However, surgery was contraindicated because of severe lung dysfunction. Moreover, he actively refused radiotherapy and endoscopic management. Therefore, the patient was given combined chemotherapy with docetaxel (65 mg/m2) and CDDP (60 mg/m2). The esophageal and gastric lesion completely disappeared on endoscopy, and there were no residual tumor cells on endoscopic biopsy after three cycles of chemotherapy. Metastatic lymph nodes also completely disappeared on the CT scan. The patient received a total of ten cycles of chemotherapy, without severe adverse effects. The patient remained asymptomatic for 18 months after discontinuation of the chemotherapy, without evidence of local recurrence or distant metastasis. Surgery or endoscopic treatment of both esophageal and gastric cancers is desirable, but, if medically inoperable, chemotherapy can be alternative treatment option.

Keyword

Multiple primary neoplasms; Esophageal neoplasms; Stomach neoplasms; Drug therapy

MeSH Terms

Aged, 80 and over
Antineoplastic Agents/therapeutic use
Cisplatin/therapeutic use
Drug Therapy, Combination
Endoscopy, Digestive System
Esophageal Neoplasms/complications/*drug therapy/pathology
Humans
Male
Positron-Emission Tomography
Stomach Neoplasms/complications/*drug therapy/pathology
Taxoids/therapeutic use
Tomography, X-Ray Computed

Figure

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  Fig. 1 Endoscopic images. (A) The image showed an elevated lesion on the left-anterior wall of the lower esophagus. (B) An 'unstained area' of the elevated lesion and the surrounding flat lesion on iodine staining was noted. (C) The image showed superficially flat and erythematous lesion on the mid antrum lesser curvature of the stomach.

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  Fig. 2 Microscopic findings (H&E). (A) Esophageal mucosa showed moderately differentiated squamous cell carcinoma (×400). (B) Gastric glands showed tubular adenocarcinoma of intestinal type (×400). The esophageal (C) and gastric mucosa (D) showed no residual tumor with mild inflammatory cell infiltration after three cycle chemotherapy (×40).

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  Fig. 3 Endoscopic images showed only a remnant scar both on the esophagus (A) and on the stomach (B).

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  Fig. 4 (A) Abdominal CT and PET CT image. Abdominal CT image suggested a single lymph node enlargement in the left perigastric area (arrow). (B) PET-CT image showed an increased flurodeoxyglucose (FDG) uptake in the lower esophagus (arrow) and no distant metastasis. The enlarged perigastric lymph node completely disappeared on abdominal CT (C) and the FDG uptake in the esophagus was not detected on the PET-CT scan after ten cycles of chemotherapy (D).

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