Endoscopic submucosal dissection after definitive chemoradiotherapy for advanced cervical esophageal cancer.

A 58-year-old man presented with dysphagia that had persisted for 6 months. EGD showed a protruding tumor in the cervical to upper esophagus (A) and another smaller tumor in the lower esophagus (18-22 cm and 38 cm from the incisors). Pathologic examination of a biopsy specimen showed squamous cell carcinoma. CT of the chest (B) and positron emission tomography—CT (PET-CT) revealed T3N1M0, stage III disease. He received definitive chemoradiotherapy with 2 cycles of platinum and 5-fluorouracil plus radiotherapy 5,000 cGy in 25 fractions and achieved partial response. A serial follow-up EGD showed nearly total tumor regression, but biopsy of the discolored mucosa at 25 and 34 cm from the incisors showed high-grade dysplasia. He refused surgery because total laryngectomy was required, and he received further chemotherapy for 18 months. EUS disclosed no obvious mass lesion, with intact muscularis propria layer; CT and PET-CT revealed persistent tumor shrinkage at the upper third of the esophagus without metastasis. The tumor was clinically downstaged to T1aN0M0. Endoscopic submucosal dissection (ESD) for residual esophageal neoplasm (C) was performed smoothly. The final pathologic report (D) showed high-grade intraepithelial neoplasia with negative margins. We assessed his condition at regular follow-up visits with EGD, CT, and PET after ESD. Neither local recurrence nor distant metastasis of the esophageal cancer has been observed for 22 months.