PMC9311332_01
Consecutive gastroscopy images showed an irregular ulcer-type tumor of about 3.0x4.0cm in size at the esophagus about 32cm away from the incisors, the surrounding mucosa was raised like a bank, the bottom was covered with dirty moss, the surface was uneven, the tissue was brittle, it was easy to bleed, and the lumen was deformed and narrowed.
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The patient, male, 47 years old, visited our hospital on July 10, 2020 due to "choking sensation after eating", and gastroscopy revealed an irregular ulcerated mass of about 3.0x4.0cm in size with a dyke-like elevation of the surrounding mucosa ( Figure 1 ).
Haematoxylin and eosin-stained sections of low-differentiated squamous cell carcinoma in the esophagus (ESCC). (On July 16, 2020, tissue biopsy specimens were taken from the lower esophagus under gastroscopy.).
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Figure 2 ), and positron emission tomography/computed tomography (PET/CT) examination for systemic evaluation suggested that the right hypopharynx had a thick wall with increased metabolism, which was considered hypopharyngeal carcinoma, and a limited hypermetabolic foci in the esophageal wall at the level of thoracic 6-10 vertebrae, which was considered esophageal carcinoma, infiltrated to the plasma membrane layer and involved the gastric cardia ( Figure 3 ). Further laryngoscopy was performed to find a mass in the right hypopharynx and tongue root ( Figure 4 ), the pathological findings were reported: hypopharyngeal invasive squamous cell carcinoma, and its immunohistochemical results showed: Ki-67(+30%),
Positron emission tomography/computed tomography (PET/CT) examination showed that: (a) the right hypopharyngeal wall was thickened with increased metabolism, hypopharyngeal cancer was considered, (b) the esophageal wall was limited to hypermetabolic foci at the level of the thoracic 6-10 vertebral body, which was considered esophageal carcinoma, infiltrated to the plasma membrane layer and involved the gastric cardia, (c) the right submandibular hypermetabolic lymph node, the small lymph nodes adjacent to the lower esophagus and the gastric cardia had slightly higher metabolism, which were all considered to be metastatic cancer.
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Figure 2 ), and positron emission tomography/computed tomography (PET/CT) examination for systemic evaluation suggested that the right hypopharynx had a thick wall with increased metabolism, which was considered hypopharyngeal carcinoma, and a limited hypermetabolic foci in the esophageal wall at the level of thoracic 6-10 vertebrae, which was considered esophageal carcinoma, infiltrated to the plasma membrane layer and involved the gastric cardia ( Figure 3 ). Further laryngoscopy was performed to find a mass in the right hypopharynx and tongue root ( Figure 4 ), the pathological findings were reported: hypopharyngeal invasive squamous cell carcinoma, and its immunohistochemical results showed: Ki-67(+30%),
Successive laryngoscopy images showed uneven masses on the right base of the tongue, the pharyngeal side, the lingual surface of the epiglottis, the lingual epiglottis folds, the floor of the right piriform fossa, and the lateral side of the right fissure. The bilateral vocal cords were smooth and the movement was good, the bilateral fissures were well moved, and the left piriform fossa was clean.
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Hematoxylin-eosin stained section of hypopharyngeal invasive squamous cell carcinoma. (On July 21, 2020, a tissue biopsy specimen was taken from the right hypopharynx under laryngoscope.).
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P40(+), CK5/6(+), P63(+) ( Figure 5 ). Pathological staging was defined according to the 8th edition of the
Time flow chart of the diagnosis and treatment process of this patient.
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American Joint Committee on Cancer (AJCC) TNM staging system, combined with clinical, imaging and pathological diagnosis results, the patient was clinically diagnosed as lower esophageal squamous cell carcinoma (cT3N2M0 stage IIIB) hypopharyngeal squamous cell carcinoma (HSCC) (cT1N1M0 stage III),and after multidisciplinary team (MDT) consultation, the patient did not meet the indications for surgical treatment and was recommended for systemic treatment in internal medicine, so he was given [Albumin-bound paclitaxel + Nedaplatin] combined with Tislelizumab immunotherapy starting on July 25, 2020 (the treatment flow chart is shown in  Figure 6 ), and after 2 courses of treatment, he felt better choking sensation in eating, and the second-stage enhanced CT of the lung showed that the esophageal lesion was smaller than before, and the response was assessed as partial remission (PR) according to the Response Evaluation Criteria in Solid Tumours 1.1 ( Figure 7 ), and no lesion was seen in the MRI of the throat on review, and the efficacy was evaluated as complete response (CR) ( Figure 8 ).
The patient's imaging examination efficacy evaluation was based on the Response Evaluation Criteria in Solid Tumours 1.1. After 2 courses of treatment, re-examination of the second-phase enhanced CT of the lungs showed that the esophageal lesions were reduced compared with the baseline, and the curative effect was evaluated as partial remission (PR).
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American Joint Committee on Cancer (AJCC) TNM staging system, combined with clinical, imaging and pathological diagnosis results, the patient was clinically diagnosed as lower esophageal squamous cell carcinoma (cT3N2M0 stage IIIB) hypopharyngeal squamous cell carcinoma (HSCC) (cT1N1M0 stage III),and after multidisciplinary team (MDT) consultation, the patient did not meet the indications for surgical treatment and was recommended for systemic treatment in internal medicine, so he was given [Albumin-bound paclitaxel + Nedaplatin] combined with Tislelizumab immunotherapy starting on July 25, 2020 (the treatment flow chart is shown in  Figure 6 ), and after 2 courses of treatment, he felt better choking sensation in eating, and the second-stage enhanced CT of the lung showed that the esophageal lesion was smaller than before, and the response was assessed as partial remission (PR) according to the Response Evaluation Criteria in Solid Tumours 1.1 ( Figure 7 ), and no lesion was seen in the MRI of the throat on review, and the efficacy was evaluated as complete response (CR) ( Figure 8 ).
After 2 courses of treatment, no lesions were found in the MRI of the throat, and the curative effect was evaluated as complete response (CR).
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American Joint Committee on Cancer (AJCC) TNM staging system, combined with clinical, imaging and pathological diagnosis results, the patient was clinically diagnosed as lower esophageal squamous cell carcinoma (cT3N2M0 stage IIIB) hypopharyngeal squamous cell carcinoma (HSCC) (cT1N1M0 stage III),and after multidisciplinary team (MDT) consultation, the patient did not meet the indications for surgical treatment and was recommended for systemic treatment in internal medicine, so he was given [Albumin-bound paclitaxel + Nedaplatin] combined with Tislelizumab immunotherapy starting on July 25, 2020 (the treatment flow chart is shown in  Figure 6 ), and after 2 courses of treatment, he felt better choking sensation in eating, and the second-stage enhanced CT of the lung showed that the esophageal lesion was smaller than before, and the response was assessed as partial remission (PR) according to the Response Evaluation Criteria in Solid Tumours 1.1 ( Figure 7 ), and no lesion was seen in the MRI of the throat on review, and the efficacy was evaluated as complete response (CR) ( Figure 8 ).
After 12 courses of treatment, re-examination of the second-stage enhanced CT of the lungs showed that the esophageal lesions were still smaller than before. Compared with that after 8 courses of treatment, the curative effect was evaluated as maintaining PR.
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After 4 and 6 courses, the efficacy was assessed as maintenance PR and maintenance CR, respectively. After completing 6 courses of chemotherapy combined with immunotherapy, the patient started [Tislelizumab] single-agent immune maintenance therapy on December 02, 2020, and the efficacy was still assessed as maintenance PR and maintenance CR, respectively, after 12 courses ( Figures 9 ,  10 ). 13 courses of immune single-agent maintenance therapy showed no disease progression after regular review, and the lesions were still in continuous remission.
After 12 courses of treatment, no lesions were found in the reexamination of throat MRI. Compared with that after 8 courses of treatment, the curative effect was evaluated as maintaining CR.
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After 4 and 6 courses, the efficacy was assessed as maintenance PR and maintenance CR, respectively. After completing 6 courses of chemotherapy combined with immunotherapy, the patient started [Tislelizumab] single-agent immune maintenance therapy on December 02, 2020, and the efficacy was still assessed as maintenance PR and maintenance CR, respectively, after 12 courses ( Figures 9 ,  10 ). 13 courses of immune single-agent maintenance therapy showed no disease progression after regular review, and the lesions were still in continuous remission.