Miraculous Response to Neoadjuvant Chemotherapy andChemoradiation in Esophageal Signet Ring Cell Carcinomawith Subsequent Recurrence
DOI:
https://doi.org/10.66765/acobs.2026.007Keywords:
Esophageal signet ring cell carcinoma, Neoadjuvant chemotherapy, Chemoradiation, Dysphagia, RecurrenceAbstract
Background: Esophageal signet ring cell carcinoma (ESRCC) is a rare, aggressive histological subtype of adenocarcinoma, comprising approximately 2.6%–5.0% of esophageal cancers. It is typically characterized by poor differentiation, diffuse infiltrative growth, rapid progression, and high metastatic potential. The role of chemotherapy and radiation in inoperable patients is yet to be defined; thus, this case report helps to add to the limited literature.
Case Presentation: A 75-year-old non-smoker, non-alcoholic male presented with difficulty in swallowing for the last 2.5 months. Upper GI endoscopy and PET-CT revealed an ulcerated lesion in the distal esophagus at 32 cm from the incisors, along with a large hiatus hernia and Barrett's esophagus. Biopsy of the lesion showed signet ring cell carcinoma. The patient received 4 cycles of neoadjuvant chemotherapy with Carboplatin (5 AUC) and 5-Fluorouracil. After multidisciplinary evaluation, the patient was considered unsuitable for surgery because of suboptimal performance status and subsequently underwent chemoradiation. Three months post-treatment, PET/CT scan showed non-FDG-avid circumferential mural thickening with no enhancement and mild luminal narrowing in the distal esophagus, likely post-RT changes. Thereafter, the patient was on regular 2-monthly follow-up and again developed difficulty in swallowing after 1.8 years, which was gradually progressing. Upper GI endoscopy revealed esophageal candidiasis and luminal narrowing at 35 cm of about 2–3 cm in length, and biopsy confirmed signet ring cell carcinoma. The patient was started on oral chemotherapy (Tab Gefitinib 250 mg OD and Tab Methotrexate 25 mg weekly). Presently, after 4 months, the patient's dysphagia score and performance status have improved.
Conclusion: Neoadjuvant chemotherapy followed by concurrent chemoradiation in the present case has shown a good response, but recurrence warrants the need for adjuvant treatment. Despite the difficulty in deriving conclusions, this case report provides insight into developing chemoradiation protocols with definitive doses. It suggests a promising role of metronomic chemotherapy with immunotherapy; however, long-term follow-up is required.
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