[Multimodal treatment of locally advanced and oligometastatic esophageal cancer]

Esophageal cancer is one of the most striking examples of the success of multimodal treatment concepts in gastrointestinal oncology. For locally advanced, resectable adenocarcinoma, perioperative chemotherapy with the FLOT regimen has replaced neoadjuvant chemoradiotherapy according to CROSS following the ESOPEC trial and represents the current standard, whereas for squamous cell carcinoma neoadjuvant chemoradiotherapy followed by surgery remains established. Immunotherapy is expanding the treatment spectrum: adjuvant nivolumab is established for residual disease after neoadjuvant chemoradiotherapy (CheckMate-577); perioperative durvalumab combined with FLOT improves event-free survival in gastric and gastroesophageal junction cancer (MATTERHORN). The SANO trial demonstrated noninferiority of active surveillance versus standard esophagectomy with respect to 2‑year overall survival in clinical complete responders; however, a decision analytical model based on the SANO data published in 2026 suggests potential long-term advantages of standard resection. In oligometastatic disease, FLOT5/RENAISSANCE showed no overall survival benefit for supplementary surgical resection and in this situation patient selection remains the central challenge. Future strategies will concentrate more on biological criteria, with a more precise definition of oligometastatic constellations, integrated immunotherapy and emerging biomarkers such as circulating tumor DNA.