Abstract:
36 years old lady known to have carcinoma of upper Esophagus /,post cricoid region 2019 august, post chemotherapy and radiation status on follow up as compared to previous PET CT 17.1.2024 present PET CT status reveals no evidence of local recurrence and no evidence of internal new metabolically active disease in present scan to suggest metastatsis, was diagnosed with Plummer Vinson Syndrome,till that date been label is as detected to have Iron deficiency Anemia and an Esophageal Web occupying half of esophageal circumference. She complained of Progressively worsening dysphagia in March 2020 and a Repeat Endoscopy showed an ulceroproliferative friable growth in post cricoid region extending inferiorly into the cervical Esophagus. Biopsy confirmed Squamous cell Carcinoma. CT-PET scan showed a large mass in the cervical esophagus and postcricoid region measuring 2.1 x 3.6 x 6 cms length compressing the trachea and abutting the Internal carotid artery with volume of 46 cc & SUV MAX = 26.1. There were enlarged necrotic lymph nodes on both sides neck which were metabolically active and appeared involved. There were no other FDG avid lesions seen elsewhere. We staged her to have a Locally Advanced Post cricoid / Upper Cervical Esophagus Cancer cT3 N2 Mo (Stage IIIB) as per AJCC 8th edition. She appears to be underweight (36Kg) with ECOG PS=1 with frail physique but had no medical co-morbidities.
She underwent Definitve Concomitant Chemoradiation with 6 cycles of weekly chemotherapy with Carboplatin & Paclitaxel along with Intensity Modulated Radiotherapy treatment (IMRT) to the Primary and Neck node regions to total dose of 58 Gy / 29 # / 6 weeks. She tolerated this treatment initially quite well and since we anticipated detriment in her Borderline Nutritional status, she was referred to me, early in course of Treatment for expert advice to increase weight as well to maintain good intensity of this diet treatment to achieve optimum outcomes and also had a Nasogastric Tube inserted early in course of her Treatment. Clinical nutritionist on assesing her find out severely malnourished,as per 3 degree ,tried building her up woth high protein nutritional supplement along with natural food preparationPatient was monitored every week for the compliance of diet .nutrition supplement was also advised to fulfil additional requirement of macro as well as micro nutrients. Total weight gain 11 kg in 6 month ,means Every month weight gain was 2.5to 4 kg, Her Diet plan: Proteins: 2.5 to 3gm per kg bodyweight total protein 90-100gm was well tolerated by her, Calorie: 40-50 calories per kg bodyweight was advised and she has tolerated very well Fat: Macro nutrient fat also 40-50 gm 50% of cancer patients suffer from a progressive atrophy of adipose tissue and skeletal muscle, called cachexia, resulting in weight loss, a reduced quality of life, and a shortened survival time. She was treated upto maximum tolerance and completed her Treatment in May 2020. We continued with her Diet Plan for the next 6 weeks and Repeat Endoscopy was Performed in July 2020 which showed only superficial ulceration with no evidence of disease. Uptodate CT-PET scan Imaging done in August 2020 showed Complete Metabolic Response with no evidence of any residual disease. Her Nasogastric tube was removed towards End of August and this lady now on her job in IT company.
