Radıatıon Induced Trıple Localızatıon of Squamous Cell Carcınoma of The Esophagus in a Woman Prevıously Treated for Breast Cancer

Background: Radiation-induced neoplasms though very rare, had been described in long-term breast cancer survivors. Multiple primary esophageal carcinomas are extremely rare. We report a case of multiple radiation induced squamous cell carcinoma of the esophagus in a woman previously treated for left breast invasive ductal carcinoma. Case presentation: A 53 year old Moroccan woman, a non-smoker, with no familial history of cancer, had a dysphasia that revealed a multiple primary esophageal squamous cell carcinoma with no distant metastases. She had previous history of breast invasive ductal carcinoma classified pT3N1M0 according to TNM classification adopted by the AJCC, grade 2 of SBR (Scaff Bloom and Richardson), with positive hormone receptors. She underwent radical mastectomy, post operatively had 6 courses of adjuvant CMF regimen followed by 50 grays of external beam radiation to the breast area, supra clavicular and the inner right mammary nodes and 5 years hormonal therapy. Esophageal carcinoma occurred 20 years after the radiation, and was treated by total oesophagectomy and three field’s lymphadenectomy. The postoperative course was dominated by an early re-intervention for mediastinal infection following an oesogastric leakage. We performed colic transplant reconstruction four months later, which was complicated by anastomotic stenosis requiring endoscopic dilatation. Conclusion: We reported an extremely rare case of triple location of radiation-induced esophageal carcinoma that occurred 20 years after thoracic adjuvant irradiation for breast cancer. This situation should be suspected as differential diagnosis in every patient presenting with a history of thoracic irradiation for primary malignancy no matter how long.