Synchronous Esophageal Squamous Cell Carcinoma And Oropharyngeal Carcinoma: Diagnosis And Management In A 45-Year-Old Patient

The occurrence of multiple primary cancers in patients is common. Esophageal squamous cell carcinoma (ESCC) may be associated with a second head and neck primary malignancy (HNSPM), which worsens prognosis. We describe here the case of a 54-year-old male with ESCC presenting as a tumor in the middle third of the thoracic esophagus, accompanied by progressive dysphagia and significant weight loss. A subsequent PET-CT revealed an oropharingeal mass that was confirmed by videofibroscopy and biopsy as a base of the tongue squamous cell carcinoma (SCC). Staging for both tumors after complete evaluation was as following: oropharyngeal tumor cT3N3bM0 and esophageal tumor cT4aN0M0. Treatment included neoadjuvant chemoradiotherapy with Carboplatin and Paclitaxel, in combination with 54 Gy radiotherapy targeting the esophageal tumor. Post-treatment imaging demonstrated regression of the esophageal tumor, but there was no clinical or imaging response of the oropharyngeal tumor. Definitive radiotherapy with concurrent Cetuximab was initiated for the oropharyngeal SCC, but due to skin toxicity (grade 3 radioepithelitis), the treatment needed interruption for a week. Follow-up CT imaging revealed a favorable response of the oropharyngeal tumor. Prospective studies are needed to identify the optimal treatment for synchronous cancers, and the multidisciplinary team (MDT) plays an important role to decide the adapted approach for these patients.