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Abstract

In Japan, two courses of CF therapy followed by surgery are accepted as a standard treatment for stage II/III oesophageal cancer according to the result of the JCOG9907 trial. However, some cases experience insufficient anti-tumour effects with CF therapy. We experienced a case with oesophageal cancer that underwent curative resection and DCF therapy after the failure of CF therapy. The patient was a 51-year-old male who visited our department due to heart burn, back pain, and weight loss since July 2014. He was diagnosed with stage III (T3N2M0) oesophageal carcinoma and started neo adjuvant CF therapy on September 19, 2014. After the first course of CF, a CT scan showed enlarged lymph node swelling and swallowing disturbance was worsened. We attempted to start DCF therapy on October 29, 2014. The feasibility of this therapy was high, with manageable grade 2 diarrhoea and a transient high fever. Swallowing disturbance further subsided during the course of treatment. After DCF treatment, a CT scan showed shrinkage of LN swelling, as well as the primary lesion. We performed videoassisted thoracoscopic oesophagectomy and 3-field LN dissection. Pathological findings showed a grade 2 histological therapeutic effects by neoadjuvant chemotherapy and down staging of the tumour to stage II (T2N2M0) was attained, which indicated curative resection was achieved. If there is a discrepancy in the anti-tumour effect between the primary lesion and LNs by neoadjuvant CF therapy for stage II/III oesophageal cancer, then conversion to DCF therapy might be one of the treatment choices.

Keywords: DCF; Oesophageal cancer; Oncology