The path of an esophageal carcinoma patient from curative to palliative treatment

  • Ercan MüldürEmail author
  • Karl Mayrhofer
  • Wolfgang Hilbe
case report


We hereby report the course and management of a patient with human epidermal growth factor receptor 2 negative esophageal cancer who received neoadjuvant chemoradiation, surgical resection and subsequently palliative therapy for recurrent disease. The critical role of the staging procedure is discussed. Additionally the options of systemic palliative therapies are presented and the rationale for immuno-oncologic treatment is highlighted. The patient received pembrolizumab as second-line therapy, which unfortunately did not result in a response and caused minor autoimmune side effects.


CROSS protocol Ivor Lewis esophagectomy Pembrolizumab Immunotherapy FLOT protocol 


Conflict of interest

E. Müldür, K. Mayrhofer, and W. Hilbe declare that they have no competing interests.


  1. 1.
    van Hagen P, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074–84.CrossRefGoogle Scholar
  2. 2.
    Lewis I. The surgical treatment of carcinoma of the oesophagus with special reference to a new operation for growths of the middle third. Br J Surg. 1946;34(133):18–31.CrossRefGoogle Scholar
  3. 3.
    Al-Batran S‑E, et al. LBA-008Docetaxel, oxaliplatin, and fluorouracil/leucovorin (FLOT) versus epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/ECX) as perioperative treatment of resectable gastric or gastro-esophageal junction adenocarcinoma: The multicenter, randomized phase 3 FLOT4 trial (German Gastric Group at AIO). Ann Oncol. 2017;28(suppl_3). CrossRefPubMedGoogle Scholar
  4. 4.
    Fuchs CS, et al. Safety and efficacy of pembrolizumab monotherapy in patients with previously treated advanced gastric and gastroesophageal junction cancer: Phase 2 clinical KEYNOTE-059 trial. Jama Oncol. 2018;4(5):e180013.CrossRefGoogle Scholar
  5. 5.
    Nishino M, et al. Anti-PD-1-related pneumonitis during cancer immunotherapy. N Engl J Med. 2015;373(3):288–90.CrossRefGoogle Scholar
  6. 6.
    Villadolid J, et al. Immune checkpoint inhibitors in clinical practice: update on management of immune-related toxicities. Transl Lung Cancer Res. 2015;4(5):560–75.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Li Z, et al. Correlation of pathological complete response with survival after neoadjuvant chemotherapy in gastric or gastroesophageal junction cancer treated with radical surgery: A meta-analysis. PLoS ONE. 2018;13(1):e189294.Google Scholar
  8. 8.
    Rizvi FH, et al. Complete pathological response after neoadjuvant treatment in locally advanced esophageal cancer predicts long term survival: A retrospective cohorte study. Int J Surg. 2014;12(6):621–5.CrossRefGoogle Scholar
  9. 9.
    Donahue JM, et al. Complete pathologic response after neoadjuvant chemoradiotherapy for esophageal cancer is associated with enhanced survival. Ann Thorac Surg. 2009;87(2):392–9.CrossRefGoogle Scholar
  10. 10.
    You JJ, et al. Clinical utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the staging of patients with potentially resectable esophageal cancer. J Thorac Oncol. 2013;8(12):1563–9.CrossRefGoogle Scholar
  11. 11.
    Meyers BF, et al. The utility of positron emission tomography in staging of potentially operable carcinoma of the thoracic esophagus: Results of the American College of Surgeons Oncology Group Z0060 trial. J Thorac Cardiovasc Surg. 2007;133(3):738–745.e1.CrossRefGoogle Scholar
  12. 12.
    Young K, et al. Ramucirumab for advanced gastric cancer or gastro-oesophageal junction adenocarcinoma. Therap Adv Gastroenterol. 2015;8(6):373–83.CrossRefGoogle Scholar
  13. 13.
    Shitara K, et al. Pembrolizumab versus paclitaxel for previously treated, advanced gastric or gastro-oesophageal junction cancer (KEYNOTE-061): a randomised, open-label, controlled, phase 3 trial. Lancet. 2018;392(10142):123–33.CrossRefGoogle Scholar
  14. 14.
    Le DT, et al. Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade. Science. 2017;357(6349):409–13.CrossRefGoogle Scholar
  15. 15.
    Le DT, et al. PD-1 blockade in mismatch repair deficient non-colorectal gastrointestinal cancers. J Clin Oncol. 2016;34(4_suppl):195–195.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medical Oncology, Hematology and Palliative CareWilhelminenspitalViennaAustria

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