Carcinoma of the cardia.An 85-year-old man with a short history of dysphagia. Endoscopy
revealed a polypoidal lesion occluding most of the lumen of the lower
esophagus. Biospied and shown to be an adenocarcinoma. The CT scan
suggested that the proximal one-third of the stomach was infiltrated
Underwent chemoradiotherapy with one cycle of cis-platinum and 5-FU and
34 Gy of radiotherapy. He had a rapid resolution of his symptoms and
the endoscopy photograph taken two weeks after completion of the
radiotherapy shows 90% disappearance of the tumor.
Comment: Traditionally adenocarcinoma of the upper digestive tract has
not been considered to respond satisfactorily to radiotherapy. However,
there are a number of studies which report positive results of
neo-adjuvant chemoradiotherapy (in combination with esophagectomy).
Both adeno and squamous cell tumors do respond to the combined therapy
and it is possible that downstaging the disease may lead to improved
survival (Bessell JR, Devitt PG, Gill PG, Goyal S, Jamieson GG.
Prolonged survival following resection of esophageal SCC downstaged by
prior chemoradiotherapy. Aust N Z J Surg 1996: 66: 214-17).
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