Neoadjuvant Docetaxel/Cisplatin/5-Fluorouracil Enabling Laryngeal Preservation in Cervical Esophageal Carcinosarcoma: A Case Report.

INTRODUCTION: Esophageal carcinosarcoma is a rare malignancy comprising both epithelial and mesenchymal components, for which no standard treatment has been established. Organ preservation in cervical esophageal malignant tumors is particularly challenging because curative resection often necessitates laryngectomy. We describe a cervical esophageal carcinosarcoma that responded markedly to neoadjuvant docetaxel/cisplatin/5-fluorouracil (DCF), permitting laryngeal preservation, with a brief literature context.

CASE PRESENTATION: A woman in her 50s presented with discomfort on swallowing. Upper endoscopy identified a type-1 polypoid tumor on the posterior wall 18 cm from the incisors, with involvement near the esophageal inlet at 17 cm. Biopsies showed a spindle-cell-predominant tumor; immunohistochemistry (cytokeratin AE1/AE3, p63) demonstrated an admixed epithelial component, supporting a diagnosis of esophageal carcinosarcoma. Contrast-enhanced CT revealed an approximately 6.5-cm exophytic lesion in the cervical to upper thoracic esophagus, and PET-CT showed intense uptake (maximum standardized uptake value 15.3). Clinical staging was cT3N0M0, cStage II (UICC TNM 8th edition). Two cycles of neoadjuvant DCF induced a dramatic response, leaving only a subtle ~5-mm proximal extension toward the right posterior wall. The patient underwent robot-assisted thoracoscopic subtotal esophagectomy with 3-field lymphadenectomy, followed by gastric conduit reconstruction through the posterior mediastinal route with cervical esophagogastric anastomosis using a 23-mm powered circular stapler. Intraoperative iodine staining delineated the proximal margin, and laryngeal preservation was achieved. Pathology showed pT1b-SM1, pN0, M0, pStage I with treatment-effect grade 1a, and the proximal resection margin was negative. Histology demonstrated a continuous transition between atypical squamous cells and spindle sarcomatous elements; the sarcomatous component exhibited inflammatory infiltrates predominantly composed of lymphocytes and foamy histiocytes, with focal hyalinization, consistent with a therapeutic effect. The postoperative course was uneventful, and the patient was discharged on day 16. No adjuvant therapy was administered. At 12 months of follow-up, no evidence of recurrence or metastasis has been observed.

CONCLUSIONS: This rare case illustrates that neoadjuvant DCF can downstage cervical esophageal carcinosarcoma and enable curative, larynx-preserving resection. Such responses support consideration of neoadjuvant chemotherapy as a strategy for functional preservation in selected patients with this histology.