Radiation Induced Triple Localization of Squamous Cell Carcinoma of The Esophagus in a Woman Previously Treated for Breast Cancer
Author: M. Sayed Naya, A. Benkabbou, H. Hachim, B. Serji, H.O. Elmalki, R. Mohsine, L. Ifrine, A. Belkouchi, A. Souadka
Category: JMSR Oncology
Abstract:
Background: Radiation-induced neoplasms though very rare, had been described in long-term breast cancer survivors. Multiple primary esophageal carcinomas are extremely rare. We report a case of multiple radiation induced squamous cell carcinoma of the esophagus in a woman previously treated for left breast invasive ductal carcinoma.
Case presentation: A 53 year old Moroccan woman, a non-smoker, with no familial history of cancer, had a dysphasia that revealed a multiple primary esophageal squamous cell carcinoma with no distant metastases. She had previous history of breast invasive ductal carcinoma classified pT3N1M0 according to TNM classification adopted by the AJCC, grade 2 of SBR (Scaff Bloom and Richardson), with positive hormone receptors. She underwent radical mastectomy, post operatively had 6 courses of adjuvant CMF regimen followed by 50 grays of external beam radiation to the breast area, supra clavicular and the inner right mammary nodes and 5 years hormonal therapy. Esophageal carcinoma occurred 20 years after the radiation, and was treated by total oesophagectomy and three field's lymphadenectomy. The postoperative course was dominated by an early re-intervention for mediastinal infection following an oesogastric leakage. We performed colic transplant reconstruction four months later, which was complicated by anastomotic stenosis requiring endoscopic dilatation.
Conclusion: We reported an extremely rare case of triple location of radiation-induced esophageal carcinoma that occurred 20 years after thoracic adjuvant irradiation for breast cancer. This situation should be suspected as differential diagnosis in every patient presenting with a history of thoracic irradiation for primary malignancy no matter how long.
Shirai K, Tamaki Y, Kitamoto Y, et al. Prognosis was not deteriorated by multiple primary cancers in esophageal cancer patients treated by radiotherapy. Journal of radiation research. Feb 4 2013.