Management of Oligometastatic Esophageal Adenocarcinoma

9 Dec 2021 02:10 02:10
Geneva
Michael F. Chevallay Host

Case 1: Distal Esophageal Adenocarcinoma With Liver Metastases After Neoadjuvant Therapy

Patient Profile & Clinical Presentation

  • Patient: 59-year-old male in excellent condition

  • Clinical Presentation: Epigastric pain and weight loss for 2 months.

Initial Diagnostic Workup

  • Gastroscopy (April 2020): Lesion at the distal part of the esophagus (35-40 cm from dental arches), developed on Barrett esophagus.

  • Biopsy: Adenocarcinoma, HER-2 negative.

  • Staging: Thoraco-abdominal PET Scan and echo-endoscopy showed no metastatic disease.

Neoadjuvant Treatment

  • Regimen: CROSS protocol.

  • Period: May – June 2020.

Restaging

  • New staging with PET-Scan and Liver MRI revealed two liver metastases.

Case 2: Distal Esophageal Adenocarcinoma With Multiple Liver Metastases and Response to Systemic Chemotherapy

Patient Profile & Clinical Presentation

  • Patient: 58-year-old male

  • Medical History: Tobacco use, chronic obstructive pulmonary disease and sleep apnea.

  • Clinical Presentation: Dysphagia and hematemesis.

Initial Diagnostic Workup

  • Gastroscopy (April 2021): Lesion at the distal part of the esophagus (38-42 cm from dental arches).

  • Echo-endoscopy Staging: uT3 N2.

  • Biopsy: Adenocarcinoma, HER-2 negative.

  • Staging: Thoraco-abdominal PET Scan showed 4 liver metastases.

Systemic Treatment

  • Regimen: FLOT protocol.

  • Period: May – June 2021.

Restaging

  • New staging with PET-Scan and Liver MRI showed regression of liver metastases.

Discussion

Management of oligo metastases.

Panel for Discussion

Local Panel (Geneva): Stefan Mönig | Minoa Jung | Olivier Huber

International Multi-disciplinary Panel: T. Goëtze, Surgical Oncology (Frankfurt, Germany) | T. Schmidt, Surgical Oncology (Köln, Germany) | T.E. Kroese, Surgery (Utrecht, Netherland) | R. Langer, Pathology (Linz, Austria) | J. Wendelmayer, Surgery (Verona, Italy) | S. Schoppmann, Surgery (Vienna, Austria)