case_images: PMC5903152_01
case_images: Computed tomography (CT) findings at diagnosis. a No metastasis was detected in the mediastinal lymph node. b Right hilar lymphadenopathy was observed. c Gastric cardia (primary lesion). d No metastasis to the para-aortic lymph node was observed.
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case_images: PMC5903152_01_cro-0011-0143-g01.jpg
case_images: F1
case_images: Computed tomography (CT) and positron emission tomography revealed metastasis to the regional and right hilar lymph nodes (Fig. 1).
case_images: Computed tomography (CT) findings before radiotherapy. a Metastasis to the pretracheal lymph node at the level of the esophagus. b Right hilar lymphadenopathy at the level of the esophagus. c Gastric cardia (primary lesion). d No metastasis was visible in the para-aortic lymph node. e The radiotherapy dose distribution.
case_images: cro-0011-0143-g02.jpg
case_images: PMC5903152_01_cro-0011-0143-g02.jpg
case_images: F2
case_images: CT revealed constriction of the gastroesophageal junction (Fig. 2). To improve the dysphagia, palliative chemoradiotherapy with S-1 and 50.4 Gy in 28 fractions was administered in August 2017; the irradiation field included the hilar lymph node, gastric cardia (primary lesion), and regional lymph nodes (Fig. 2).
case_images: Clinical course following the administration of nivolumab. a Computed tomography (CT) findings upon completing radiotherapy; the tumor was still visible. b CT findings 14 days after the first administration of nivolumab; all lesions rapidly progressed.
case_images: cro-0011-0143-g03.jpg
case_images: PMC5903152_01_cro-0011-0143-g03.jpg
case_images: F3
case_images: CT findings before commencing nivolumab are shown in Figure 3a. CT performed 15 days following the first administration of nivolumab revealed rapid progression in the irradiation field (Fig. 3b).