Optimum Treatment of Carcinoma Esophagus in Geriatric Age with Multiple Comorbidities- A Case Report with Review of Literature

Abstract

Introduction: Standard management of concurrent chemo radiotherapy (CCRT) in upper and middle 1/3rd of cancer esophagus may be challenging to practice in the geriatric age group with multiple comorbid conditions. The treatment may lead to life threatening side effects while compromised treatment may lead to failure of the case. The present case reports the treatment of cancer esophagus patient in geriatric age group with multiple comorbidities treated with standard regimen of concurrent chemoradiation. Case History: Sixty years old male with several comorbid conditions presented to our OPD with complaints of difficulty in swallowing in the past 6 months. Upper gastrointestinal endoscopy revealed ulcerated mass whose biopsy was suggestive of moderately differentiated squamous cell carcinoma. Positron emission tomography- computed tomography whole body scan revealed localized well-defined lesion in upper one third of the esophagus. Echocardiography (2D Echo) showed cardiac comorbidity for which medications were prescribed and close monitoring was done by cardiologist. Diabetes was monitored by general physician and proper diet by nutritionist. Patient was treated with standard CCRT protocol. There were no significant toxicities related to radiotherapy and chemotherapy. After 1 month of treatment upper gastrointestinal endoscopy revealed normal benign esopheagal mucosa. Follow up PET CT was done after 3 months which showed significant decrease with no new lesion. After one year follow up patient has no complaints of dysphagia. Conclusion: Geriatric patients of upper or middle 1/3rd esophagus can be treated with standard chemo radiotherapy regimes by radiation oncologist in association with team of other physicians with regular monitoring of the comorbid conditions.