Case report and literature review on oxaliplatin and tegafur for AEG with intramural metastasis

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Frontiers in Medicine Published May 11, 2026 Medically reviewed May 11, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Note that intramural metastasis indicates systemic disease and warrants multidisciplinary management.

This publication is a case report and literature review focusing on adenocarcinoma of the esophagogastric junction and esophageal intramural metastasis. The scope includes a single 77-year-old male patient who received neoadjuvant chemotherapy with oxaliplatin and tegafur, followed by lower esophagectomy, total gastrectomy, and postoperative radiotherapy. The review incorporates data from six additional relevant articles to contextualize the findings.

The authors synthesize that the prognosis is poor. They note that tumor cells primarily spread through venous and lymphatic channels within the esophageal wall. Additionally, the presence of intramural metastasis is described as an indicator of systemic disease rather than a localized issue.

The review does not report adverse events, tolerability, or discontinuations. The authors highlight that detection warrants prompt recognition and a multidisciplinary, individualized treatment strategy. Given the small sample size and observational nature of the evidence, these conclusions are presented with appropriate caution regarding generalizability.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

BackgroundIntramural metastasis from adenocarcinoma of the esophagogastric junction (AEG) to the esophagus is a rare event and is associated with a poor prognosis.Case summary and literature reviewWe report a 77-year-old male patient diagnosed with AEG with esophageal intramural metastasis. Upper gastrointestinal endoscopy revealed an infiltrative ulcerative tumor at the esophagogastric junction and a submucosal protrusion in the middle esophagus. Biopsies from both lesions confirmed moderately to poorly differentiated adenocarcinoma. The patient received seven cycles of neoadjuvant chemotherapy (oxaliplatin and tegafur), followed by lower esophagectomy and total gastrectomy. Postoperative radiotherapy was administered for residual esophageal metastasis. Although the patient initially improved, he died approximately three years after surgery. A systematic search of PubMed, Embase, and Web of Science identified six relevant articles on esophageal intramural metastasis from AEG. The findings suggest that tumor cells primarily spread through venous and lymphatic channels within the esophageal wall. The presence of intramural metastasis on endoscopy indicates systemic disease and a poor prognosis. An individualized treatment approach, potentially combining neoadjuvant chemotherapy, radiotherapy, immunotherapy, and surgery, may offer the best outcome.ConclusionEsophageal intramural metastasis from AEG is a rare but aggressive metastatic pattern. Its detection warrants prompt recognition and a multidisciplinary, individualized treatment strategy.