Carcinoma of the pyriform sinus with mediastinal metastasis successfully treated with chemoradiotherapy in resource-constraint setup

Squamous cell carcinoma (SCC) of the pyriform sinus with metastatic mediastinal mass is staged as IVC and routinely treated with palliative intent. Here, we report a case cured with radical chemoradiotherapy without CT simulator, lead cutouts, and advanced techniques such as three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, image-guided radiotherapy, and volumetric modulated arc therapy or stereotactic body radiotherapy. A 67-year-old male presented with SCC of the right pyriform sinus with mediastinal metastasis (Stage IVC). He was started with palliative chemotherapy afferent, but he could not tolerate it. Further, he was treated with radical chemoradiotherapy to dose of 60/30# to primary + neck with 6 MV photons and 50 Gy/25# to the anterior mediastinal lesion using 18 Mev electrons. Complete response to the treatment was achieved. At the close follow-up of 58 months, the patient is disease-free and follow-up is still ongoing. Limited metastatic disease can be completely cured using multimodality treatment using simple traditional 2D techniques, though optimal dose escalation becomes a limitation. Some variants of SCC do respond well even at suboptimal radiotherapy doses, so personalized treatment can be considered in such patients.