Case Report: Solitary adrenal metastasis from esophageal adenocarcinoma

Solitary adrenal metastasis from a primary esophageal malignancy is relatively rare. While there are case reports of aggressive treatment with esophagectomy and adrenalectomy providing long-term survival, the treatment paradigm is not well defined. Complications from esophageal adenocarcinoma and its treatment can significantly impact the patient's quality of life and prognosis.

Our patient was treated with systemic therapy and, although he initially had a complete response, he later experienced local disease progression along with the development of additional metastatic sites. The patient began FOLFOX, a standard chemotherapy regimen for esophageal/gastric cancer. He experienced side effects such as fever, malaise, and constipation, which were symptomatically managed. Given these side effects, the patient's FOLFOX regimen underwent a 25% dose reduction of the 5FU bolus. A PET/CT scan after three months showed a marked response to chemotherapy, with complete resolution of detectable disease. The patient reported fatigue, bone pain managed with Neulasta, nausea controlled with antiemetics, and neuropathy in his feet. The patient then began a new chemotherapy regimen with Taxol/Ramucirumab with dose modifications in response to side effects. Continued adjustments to the treatment and dosages were made for progressive side effects and the patient elected to receive palliative radiation to the esophagus, along with holistic supportive care. The treatment plan shifted to palliative care, focusing on quality of life, rather than curative, due to the complexities of his cancer.

While aggressive treatments may offer hope for a cure in select patients with isolated adrenal metastasis from esophageal cancer, the general approach should remain cautious, with systemic therapy as the first line of defense. This case highlights the need for careful selection to identify patients who may benefit from aggressive surgical treatment. Ongoing research and clinical trials are needed to better define treatment protocols and improve outcomes for this challenging patient group.