Updated German S3 guideline on diagnosis and treatment of squamous cell carcinomas and adenocarcinomas of the esophagus (version 4.0)

Precise tumor staging is necessary to offer patients stage-specific treatment after diagnosis of esophageal cancer. High-grade intraepithelial neoplasms and mucosal cancer should be endoscopically resected. Esophagectomy should be performed minimally invasively or in combination with open procedures (hybrid technique). As the prognosis of locally advanced esophageal cancer after surgery alone is poor, multimodal therapy is recommended. In the case of locally advanced adenocarcinoma of the esophagus or esophagogastric junction, perioperative chemotherapy or preoperative radiochemotherapy is performed. In locally advanced esophageal squamous cell carcinoma, preoperative radiochemotherapy followed by complete resection or definitive radiochemotherapy without surgery is recommended. In the case of residual tumor in the resection specimen after neoadjuvant radiochemotherapy and R0 resection of squamous cell or adenocarcinoma, adjuvant immunotherapy with nivolumab should be performed. Systemic palliative treatment options (chemotherapy, chemotherapy plus immunotherapy, immunotherapy alone) for patients with inoperable or metastatic esophageal cancer depend on histology and are stratified according to PD-L1 and/or Her2 expression.