Multimodal treatment including surgery for esophageal adenocarcinoma with liver oligo-metastases: a pathological complete response but early brain metastasis

Survival of patients with stage IV esophageal adenocarcinoma is exceedingly poor, with less than 5% surviving 5 years. Current National Comprehensive Cancer Network guidelines recommend only palliative and supportive measures for patients with metastatic esophageal cancer. Treatment for stage IV disease is chemotherapy in selected patients, while the role of radiation therapy and surgical resection remain controversial. We report herein a young patient with esophageal adenocarcinoma and synchronous liver metastasis who underwent induction chemotherapy with encouraging downstaging, then two-field esophageal resection with left liver lobectomy. Despite a complete response of esophageal and residual liver lesions, early progression with isolated brain metastasis occurred 2 months after discharge. Our case highlights that despite progress in perioperative chemotherapy, the role of surgery remains uncertain for patients with esophageal cancer and synchronous M1 disease who exhibit excellent response to neoadjuvant treatment.