A case of multiple liver and celiac lymphnode metastases after curative esophagectomy for esophageal cancer successfully treated with hepatic arterial infusion and radiation therapy

A 65-year-old woman, who had been operated by subtotal esophagectomy for esophageal cancer, was diagnosed as multiple liver metastases and celiac lymphnode metastases one year after operation. The response evaluation revealed progressive disease after she had been suffering from nausea and anorexia throughout 2 courses of FP therapy. She refused to continue any more systemic chemotherapy, so we proposed an alternative to her, hepatic arterial infusion chemotherapy (HAI) for multiple liver metastases and radiation therapy for celiac LN metastases. Despite the marked reduction of all target lesions and maintenance of tumor marker level below the normal limits after 50 Gy of irradiation and 5 courses of HAI, a novel solitary tumor had appeared in S3 of the liver and an abdominal pain during HAI had occurred at the end of 5th course of HAI. The angiogram revealed occlusion of hepatic artery, suggesting that the emergence of new lesion was attributed to unequal distribution of the drug. Six weeks after a cessation of HAI, a subsequent CT scan showed a rapidly enlarged new lesion in S3, so that a surgical resection for this tumor was performed. The patient is alive without recurrence more than 10 months after the diagnosis of multiple liver metastases (2 months after the last surgery).