Chemoradiotherapy regimens for patients with
esophageal cancer intolerant to standard
therapies remain to be established. The standard
therapy for patients with stage II-III
esophageal squamous cell carcinoma, who are not surgical candidates, is definitive
chemoradiotherapy with concomitant use of
5-fluorouracil and
cisplatin; however,
cisplatin can cause serious adverse events. An 83-year-old Japanese man developed a 2-month history of
nausea and
vomiting. Contrast-enhanced computed tomography revealed concentric wall thickening in the mid-to-lower esophagus with surrounding regional lymph node swelling. Upper gastrointestinal endoscopy revealed an ulcerated
tumor with raised margins in the middle esophagus. He was diagnosed with stage IIIB (T3N2M0)
esophageal squamous cell carcinoma, pathologically exhibiting squamous epithelium-like invasive abnormal structure with atypical cells. He underwent
chemoradiotherapy involving four-dimensional
conformal radiotherapy and single-agent S-1 rather than the standard
chemoradiotherapy, and achieved clinical remission 2 months later on endoscopy and computed tomography. The patient died 1 year later due to
pneumonia, and the autopsy did not reveal any evidence of
squamous cell carcinoma in the esophagus, surrounding lymph nodes, or other organs, suggesting pathologically complete remission. Concurrent single-agent S-1
chemoradiotherapy may induce complete remission of stage IIIB
esophageal cancer and is a possible alternative for older patients or those with multiple comorbidities.