Long-Term Survival in Stage IV Esophageal Adenocarcinoma with Chemoradiation and Serial Endoscopic Cryoablation

Abstract

Esophageal cancer has a poor overall prognosis and is frequently diagnosed at a late stage. Conventional treatment for metastatic esophageal cancer involves chemotherapy and radiation. Local disease control plays a significant role in improving survival. Endoscopic spray cryotherapy is a novel modality that involves freezing and thawing to produce local ablation of malignant tissue via ischemic mechanisms. Spray cryotherapy has been shown to be effective, particularly for early T-stage, superficial esophageal adenocarcinomas. We present the case of a 72-year-old-male with locally recurrent stage IV esophageal adenocarcinoma and long-term survival of 7 years to date, with concurrent chemoradiation and serial cryoablation. He remains asymptomatic and continues to undergo chemotherapy and sequential cryoablation. The findings highlight the long-term safety and efficacy of cryotherapy in combination with chemoradiation, and suggest that cryoablation may have an additive role in the treatment of advanced stage esophageal adenocarcinoma.

Keywords: Adenocarcinoma; Cryosurgery; Esophageal neoplasms.

Fig. 1.

(A) Positron emission tomography-computed tomography and endoscopic images demonstrating recurrent tumor after 1 year of chemoradiation to the distal esophagus (white arrow). (B) Tumor significantly regressed after cryoablation ×2 (blue arrow). (C) Most recent imaging 7 years after concomitant chemotherapy and serial cryoablation (yellow arrow).

Fig. 2.

Endoscopic image of distal esophageal adenocarcinoma following application of spray cryoablation.