A 55-year-old man was referred to our hospital in November 2005 for odynophagia and oral bleeding. Physical examination revealed a necrotic ulcer 4-5 cm in diameter in the tonsillar pillar and left tonsil, which was biopsied and found to be squamous cell carcinoma. The CT scan showed ipsilateral laterocervical adenopathies, both submaxillary and jugulodigastric. Blood tests and other examinations were normal. A diagnosis of locally advanced squamous cell carcinoma of the oropharynx (T3-N2b-M0, Stage IVa) was established and chemoradiotherapy treatment was started. Treatment consisted of hyperfractionated radiotherapy (120 cGy per fraction, 2 fractions/day, up to 7,680 cGy), and cisplatin, 20 mg/m2/day in continuous perfusion for 120 hours, between days 1-5 and 21-25 of treatment. At the end of treatment, both physical examination and CT scan showed complete response.
The patient remained asymptomatic until March 2007 when he came to our hospital with asthenia, instability and abdominal pain followed by massive haematemesis with clinical and haematological involvement (Hb 7.1g, haematocrit 21.5%). Gastroscopy showed an ulcerated tumour in the distal oesophagus, over the cardia extending to the greater curvature and anterior and posterior face of the stomach. The result of the biopsy was epidermoid carcinoma compatible with metastasis of laryngeal carcinoma.

Throughout the hospital stay, several transfusions were necessary and treatment with somatostatin was started, despite which the bleeding remained active. Palliative radiotherapy treatment was then started with haemostatic intent, administering 20Gy in 5 fractions of 400cGy with good digestive tolerance and achieving remission of the bleeding episodes. The patient was discharged and remained asymptomatic for another 5 months, after which he died of metastatic dissemination.