Treatment of Fanconi anemia patient with synchronous esophageal and tongue cancer in COVID-19 era - a case report

Sep 22, 2026

Although Fanconi anemia patients have a high risk of multiple cancers, radiotherapy is often limited because of concerns about severe radiation toxicity arising from extreme sensitivity to DNA damage. This case report describes a 28-year-old female with synchronous esophageal and tongue cancer who received two radiation courses during coronavirus disease 2019 infection. She received 30 Gy preoperatively to the esophagus and 27 Gy postoperatively to the tongue surgical bed. She maintained a no-evidence-of-disease status for 7 months without severe complications. The report supports feasibility and highlights the potential importance of dose de-escalation and careful retreatment planning.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Introduction

Fanconi anemia and radiation sensitivity

Rationale for radiotherapy under guidelines

Case Report

Presenting symptoms and diagnosis

COVID-19 impact on treatment planning

Radiotherapy planning and delivery

Case Report pISSN 2234-1900 · eISSN 2234-3156 Radiat Oncol J 2024;42(1):83-87 [https://doi.org/10.3857/roj.2023.00654](https://doi.org/10.3857/roj.2023.00654) Treatment of Fanconi anemia patient with synchronous esophageal and tongue cancer in COVID-19 era: a case report Tae Hyun Kim1,2, Jin Ho Kim2, Chang Hyun Kang3, Bhumsuk Keam4, Hak Jae Kim2 1 Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea 2Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea 3Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea 4Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea Received: August 4, 2023 Revised: October 25, 2023 Accepted: October 27, 2023 Correspondence: Hak Jae Kim Department of Radiation Oncology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. Tel: +82-2-2072-2520 [E-mail: khjae@snu.ac.kr](E-mail: khjae@snu.ac.kr)[ ](E-mail: khjae@snu.ac.kr)ORCID: [https://orcid.org/0000-0003-3602-2263](https://orcid.org/0000-0003-3602-2263) Although Fanconi anemia patients accompany a high risk of multiple cancers, radiation therapy on these patients has been carried out only in limited cases due to the concern for radiation toxicity that stems from their susceptibility to radiation. We report a case of a 28-year-old female patient diagnosed as synchronous esophageal and tongue cancer, and underwent two cycles of radiation therapy, inevitably in the condition of coronavirus disease 2019 infection. She received radiation therapy of 30 Gy to esophageal mass with neoadjuvant aim in her first-round radiation therapy, and later received 27 Gy to tongue cancer surgical bed with adjuvant aim in her second-round radiation therapy. With no further treatment, she has been maintaining no evidence of disease state for 7 months. Managing Fanconi anemia patients with multiple cancers using radiation therapy is feasible, in which cases a dose de-escalation may be important considering the radiation toxicity and possible future re-treatment. Keywords: Radiotherapy, Head and neck neoplasms, Esophageal neoplasms, Radiation injuries, COVID-19 Introduction Fanconi anemia (FA) is a rare congenital syndrome that presents with aplastic anemia and bone marrow hypoplasia in young age and develops myelodysplastic syndrome (MDS) and acute myeloid leukemia during the life course [1]. FA is caused by a defect in a tumor-suppressive pathway, which protects the human genome and maintains genomic stability by repairing DNA interstrand crosslinks [2]. The resulting consequence is skin anomalies including hyperpigmentation and café-au-lait spots (approximately 40%), skeletal anomalies of the head including microcephaly and hydrocephaly (approximately 20%), increased risk of MDS (approximately 6,000-fold greater risk) and leukemia (approximately 700-fold greater risk), increased risk of solid tumor (more than 10% per year by age 45) [3,4] Another clinical significance of FA patients regarding radiation treatment stems from their inherent sensitivity to DNA damage and the resulting toxicity of varying degrees. Some suggest that the risk of mortality after radiotherapy in FA, pertaining to either acute or chronic radiation toxicity, may amount to as high as 50% [5]. Even those who survive radiotherapy may experience severe local symptoms such as mucositis, dysphagia, stenosis, wound problems, as well as systemic symptoms, the most notable being bone marrow failure. Thus, completion of radiotherapy in an uninterrupted schedule may be limited in many cases, and guidelines recommend radiotherapy to be used only in circumstances of absolute necessity [5,6]. Here, we present a case of a 28-year-old female patient who was diagnosed with synchronous esophageal and tongue cancer and u

FAQs

Why is radiotherapy challenging for patients with Fanconi anemia?

Fanconi anemia causes heightened sensitivity to DNA damage, leading to serious acute and chronic radiation toxicity. As a result, radiotherapy is generally recommended only when absolutely necessary.

What cancer types were treated in this case report?

The patient had synchronous esophageal cancer and tongue cancer, confirmed by biopsy and supported by imaging findings.

What radiation regimens were delivered for the two treatment rounds?

The first round used 30 Gy to the esophageal mass with a neoadjuvant aim, and the second round used 27 Gy to the tongue cancer surgical bed with an adjuvant aim.

Sep 22, 2026

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