Exploration of preventive treatment for high risk patients with metachronous multiple esophageal squamous cell carcinoma: A case report

Metachronous multiple esophageal squamous cell carcinomas (ESCCs) may occur in some patients after endoscopic resection. Multiple dysplastic lesions in the esophagus increase risk of multiple squamous cell carcinomas (SCCs). Endoscopic imaging technology such as narrow band imaging (NBI), can detect early SCC. Lugol chromoendoscopy is also the conventional standard technique for detecting superficial ESCC. However, little is known about the interval from the first SCC to the metachronous SCC. Effective methods to prevent multiple metachronous SCCs are needed in survivors of esophageal SCC.

A 56-year-old man showed a slightly elevated reddish area in the middle thoracic esophagus at 30 cm from the incisors on gastroscopy for routine examination. Esophageal mucosa lesion was about 2.5 cm. NBI and magnifying gastroscopy confirmed intra-epithelial papillary loop type B-1 according to the Japan Esophageal Society Classification. Lugol chromoendoscopy was used to evaluate the dysplastic squamous epithelium in the esophagus. Biopsy pathology revealed severe dysplastic squamous epithelium. Computed tomography showed no lymph node metastasis. His complete blood test and tumor markers were within reference values. He had no history of alcohol consumption and smoking. Mucosal lesion was dissected by endoscopic submucosal dissection (ESD). Postoperative pathological results showed moderately differentiated squamous carcinoma. No cancer thrombus was seen in the vasculature, and the surrounding cut edge was not involved. The patient underwent radiotherapy within 2 months after ESD. The multiple Lugol-voiding lesions disappeared, and enhanced chest computed tomography revealed no lymph node metastasis.

This is the first case of multiple dysplastic lesions of esophagus cured by radiotherapy. Radiotherapy after minimally invasive endoscopic treatment might be a safe and effective optional therapeutic strategy to prevent metachronous multiple esophageal SCCs.