Multidisciplinary Comprehensive Treatment for a Challenging Case of Esophageal Cancer

24 Jan 2026 13:00 14:30
Beijing
Jie He Host
You-Sheng Mao Host

Patient Profile & Initial Presentation

  • Patient: 62-year-old male

  • Clinical Presentation: Dysphagia and semi-liquid diet for over 6 months, since May, 2024, with weight loss of 5 kg.

  • Symptoms: No chest/back pain, hoarseness, or cough reported.

  • Gastroscopy: Esophageal mass 25-28 cm from the incisors.

  • Pathologic Examination: Squamous cell carcinoma.

  • Chest CT with contrast and PET/CT: Thickening of the upper thoracic esophagus with intensely increased fluorodeoxyglucose (FDG) uptake (A).

  • N°106R lymph node: Enlarged with hypermetabolism (B).

Free registration

A. Tumour before treatment    B. N°106R lymph node before treatment

Past Medical History

  • Grade 3 Hypertension: Over the past 30 years, currently treated with Irbesartan and Metoprolol.

  • Type 2 Diabetes Mellitus: Over 15 years, currently taking Glimepiride.

Personal History

  • Alcohol Consumption: For 20 years, approximately 500 ml/day, stopped 7 months ago.

  • Smoking History: Denied.

Initial Diagnosis

  • Upper thoracic ESCC: cT3N1M0 - Stage III (AJCC 8th Edition).

  • Comorbidities: Grade 3 Hypertension. Type 2 Diabetes Mellitus.

Course of Treatment

Neoadjuvant Chemo-immuno-therapy (External Hospital)

  • Regimen: Albumin-bound Paclitaxel + Carboplatin + Camrelizumab.

  • Treatment: 2 cycles (11/27/2024; 12/16/2024).

  • Evaluation (01/13/2025): Chest CT with contrast: Stable disease (SD) with shrinkage (C, D).

C. Tumour after 2 cycles    D. N°106R lymph node after 2 cycles

Definitive Radiotherapy (External Hospital)

Definitive Radiotherapy was selected for the patient due to pulmonary embolism in the right middle lobe artery without symptom detected by chest CT.

E. 1-month post-definitive radiotherapy    F. 2-month post-definitive radiotherapy

Surgical Exploration (External Hospital)

  • 05/10/2025: Inferior vena cava filter placement.

  • 05/15/2025: Thoracoscopy: surgical exploration revealed severe adhesion between esophagus and aorta, leading to stop of the procedure.

Re-evaluation (Our Hospital)

  • Clinical Status: The patient experienced dysphagia, able to tolerate semi-liquid diet.

  • Symptom: Severe back pain.

  • Esophageal MRI: ycT4bN1M0 (Upper thoracic esophageal wall thickening, indistinct adventitia, unclear boundary with the posterior tracheal wall, and enlarged N°107 lymph nodes) (G).

G. Esophageal MRI

H. Bronchoscopy: Normal mucosa of the trachea and bilateral main bronchi.

Gastroscopy and Biopsy: Esophageal ulcerative mass at 24-28 cm from the incisors. Consecutive tissue biopsy showed atypical cell infiltration, consistent with squamous cell carcinoma.

Surgery (Our Hospital)

  • Procedure: Thoracoscopy and laparoscopy-assisted salvage Mckeown procedure via retrosternal approach (06/05/2025).

  • Intra-operative Frozen Pathology Examination: Chest wall invasion tissue showed necrosis and fibrous connective tissue. No cancer cells.

  • Tracheal Invasion Site: Submitted tissue showed no carcinoma.

Postoperative Pathology

  • Diagnosis: Upper thoracic ESCC, ypT4N0M0 (TRG Grade 3).

  • Lymph Nodes: N°107+108LN 0/9; N°110+111LN 0/2; N°G1+G2LN 0/3; N°G3+G7LN 0/12.

  • PD-L1: 22C3.

Postoperative Follow-up

Chest CT with contrast showed no recurrence 6 months later (12/17/2025).

Panel for Discussion

Dai Liang (Beijing) | Guo Xufeng (Shanghai) | Huang Wei (Shangdong) | Kang Xiaozheng (Beijing) | Leng Xuefeng (Sichuan) | Li Wenya (Shenyang) | Li Yong (Beijing) | Lu Zhihao (Beijing) | Piessen Guillaume (Lille) | Shi Yanjie (Beijing) | Sun Haibo (Henan) | Wang Feng (Zhengzhou) | Wang Zhen (Beijing) | Yang Hong (Guangzhou) | Yuan Yong (Chengdu) | Zheng Bin (Fuzhou)

Topics for Discussion

  1. Initial staging and neoadjuvant approach: What was the initial stage of the esophageal cancer? What mode should be adopted for neoadjuvant treatment?

  2. Treatment response and strategy adaptation: What was the efficacy evaluation of the post-neoadjuvant treatment, and what is the subsequent treatment strategy?

  3. Impact of thromboembolic event: Was the treatment strategy for the cancer changed due to the occurrence of pulmonary embolism without symptoms during the pre-operative systemic treatment?

  4. Salvage surgery: indications and prognosis: Indications for salvage surgery in patients with residual tumors after radical radiotherapy for esophageal cancer, and prognosis for such patients.

  5. Management after non-radical resection: What is the treatment to apply after non-radical resection of esophageal cancer?