Female patient, 69 years old, locally advanced esophageal cancer

[Typical Case] Carbon Ion Therapy for a Patient with Locally Advanced Esophageal Cancer

Clinical History:
A 69-year-old female developed dysphagia on October 10, 2023, progressing to tolerating semi-liquid diets. On December 26, 2024, PET-CT at our hospital revealed:

• Focal wall thickening and mass formation in the lower thoracic esophagus
• Increased metabolic activity
• Corresponding luminal stenosis Findings consistent with esophageal cancer.

Endoscopic Ultrasound (EUS):

• At 31-35 cm from incisors: Mucosal irregularity with semi-circular elevated lesion Ulceration with white slough Luminal stenosis Blurring of mucosal/submucosal/muscularis propria layers Layer thickening: 11.8–14.8 mm
• Pathology: Poorly differentiated squamous cell carcinoma.

Diagnosis: Squamous cell carcinoma of lower esophagus， Metastatic mediastinal lymph nodes， Stage cT3N1M0 (IIIB)

Treatment:
Following multidisciplinary team (MDT) discussion:

• Concurrent carbon ion radiotherapy + capecitabine chemotherapy
• Post-7 carbon ion sessions (EUS re-examination):Lesion thickness: 12.9–14.2 mm
• Treatment plan redesigned → 8 additional carbon ion sessions
• Post-treatment EUS:Lesion thickness reduced to 5.0–6.0 mm
• Outcome: Dysphagia resolved; tolerating soft diet.

Figure 1: Pre-treatment EUS (2024-12-28)  *At 31-35 cm from incisors:*
Mucosal irregularity, semi-circular elevated lesion with ulceration and white slough. Luminal stenosis. Blurred mucosal/submucosal/muscularis propria layers. Thickness: 11.8–14.8 mm.

Figure 2: Interim EUS (2025-01-14)    *At 31-35 cm from incisors:*
Mucosal irregularity, semi-circular elevated lesion, luminal stenosis. Blurred layers. Thickness: 12.9–14.2 mm.

Figure 3: Post-carbon ion therapy EUS (2025-01-26)*At 27-31 cm:* Mucosal irregularity with localized pallor.
*At 31-35 cm:* Mucosal irregularity, semi-circular elevated lesion, luminal stenosis. Blurred layers. Thickness: 5.0–6.0 mm.

Figure 4: 2.5-month post-therapy EUS (2025-03-13)
*At 29-31 cm:* Mucosal irregularity with pallor. Blurred layers. Thickness: 3.7–4.4 mm.

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