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Upper GI: Definitive chemoRT for oesophageal SCC

Free question published 06 August 2026

Upper GIDefinitive chemoRT for oesophageal SCC

A 74-year-old woman with a cT2N0M0 squamous cell carcinoma of the mid-oesophagus has significant comorbidity and, after discussion, wishes to avoid oesophagectomy. She has WHO performance status 1 and the tumour is encompassable within a radical radiotherapy field. What is the most appropriate radical treatment to offer?

  1. ARadiotherapy alone without concurrent chemotherapy
  2. BPerioperative FLOT chemotherapy then surgery
  3. CPalliative single-fraction radiotherapy
  4. DOesophagectomy regardless of patient preference
  5. EDefinitive (radical) chemoradiotherapy

Why E is correct

NICE NG83 recommends offering people with resectable non-metastatic squamous cell carcinoma of the oesophagus the choice of radical chemoradiotherapy or chemoradiotherapy before surgical resection. For a patient who declines surgery, definitive (radical) chemoradiotherapy is the appropriate curative-intent option, and the guideline notes standard radical treatment for oesophageal squamous cell carcinoma is usually chemoradiotherapy.

And why the others are not

  • ARadiotherapy alone is inferior to combined chemoradiotherapy, which is the standard radical non-surgical treatment for oesophageal squamous cell carcinoma.
  • BPerioperative FLOT is the regimen for gastro-oesophageal adenocarcinoma, not squamous cell carcinoma, and still requires surgery the patient wishes to avoid.
  • CSingle-fraction palliative radiotherapy abandons curative intent in a patient with localised, potentially curable disease and good performance status.
  • DImposing oesophagectomy against the patient's expressed preference is inappropriate when an equivalent curative-intent non-surgical option exists.

Source NICE NG83 - Oesophago-gastric cancer: assessment and management in adults — National Institute for Health and Care Excellence. Oesophago-gastric cancer: assessment and management in adults. NICE guideline NG83. Published 24 January 2018.

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