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.