Esophageal Cancer&nbsp;&nbsp;&nbsp;

Would you use triplet chemotherapy FLOT in lieu of chemoRT for patients with localized esophageal squamous cell carcinoma?

While ESOPEC excluded squamous cell carcinoma, the Japanese JCOG1109 NExT trial also showed superiority of fluoropyrimidine/platinum/taxane over chemo...

For a patient with T3N1M0 esophageal adenocarcinoma, who suffered esophageal perforation necessitating metallic stent placement, would you favor a neoadjuvant chemoradiation or perioperative chemotherapy approach?

Assume the patient is a good surgical candidate, and the perforation happened prior to initiating any treatment. Is the stent enough reason to avoid c...

How would you approach treating a patient who refuses surgery, but has significant residual disease after chemoradiotherapy for squamous cell carcinoma of the esophagus?

Tumor is PD-L1 positive and HER2 positive

Given the results of ESOPEC from ASCO 2024, for which patients with resectable esophageal adenocarcinoma would you favor neoadjuvant chemoradiation?

ESOPEC compared perioperative FLOT vs neoadjuvant chemoradiation per the CROSS trial, and showed superior OS with perioperative FLOT. What concerns do...

Does an esophageal stent impact your radiation treatment plan for a patient with non-metastatic GE junction adenocarcinoma?

In general, how does an esophageal stent affect what you might consider in terms of radiation dose and volume?

6 Answers available

For a patient who has T4 squamous cell esophageal carcinoma on imaging, and who has biopsy-confirmed disease in an involved local lymph node, are EUS or EGD still indicated to complete workup?

How do you treat locally advanced, operable, Siewert 3 GE junction adenocarcinomas?

What is the highest dose to which you treat a locally advanced esophageal cancer with a stent in place?

Would you ever treat with definitive intent in a "curative" patient who has a stent placed, or only palliatively? Does the addition of chemotherapy or...

For an otherwise resectable esophageal cancer with involved celiac lymph nodes, would you ever consider an SIB beyond 50.4 Gy?

Assuming duodenum constraints are met, could there be any benefit to boosting a positive celiac node to 61.6 Gy in 28 fractions?

For esophageal adenocarcinoma with extensive associated Barrett's, would you extend your CTV coverage beyond the usual expansions to cover the areas of known Barrett's?

Would it make a difference whether the patient was planned for chemoradiation followed by surgery or definitive nonoperative chemoradiation?

How would you alter your treatment volumes in a patient with distal esophageal cancer who has had prior gastric bypass surgery?

Would you ever offer adjuvant immunotherapy after definitive chemoradiation for esophageal cancer?

Would you consider SBRT or more conventionally fractionated radiation for an in-field mediastinal recurrence of esophageal adenocarcinoma s/p preoperative CRT, esophagectomy, and now progressing on immunotherapy?

How would your decision differ if the patient was not on immunotherapy or other systemic therapy? Would your thinking differ depending on the timing o...

How do you approach borderline non-regional mediastinum lymph nodes when treating locally advanced esophageal cancer?

How do you follow up a patient with esophageal adenocarcinoma who is not a surgical candidate after finishing chemoradiation?

Would you offer a palliative or more aggressive course of radiation therapy for a symptomatic isolated supraclavicular recurrence of a squamous cell carcinoma of the esophagus?

What would your approach be in a patient with a mid-esophageal squamous cell carcinoma treated with chemoradiation therapy followed by surgery, with P...

Can the results of Checkmate 577 be applied to patients who do not undergo surgery following chemoradiation because of a clinical complete response?

What about for a patient with complete radiographic response who declines surgical management?

Can CM577 regimen of adjuvant nivolumab s/p neoadjuvant chemoRT with residual disease following surgery be extrapolated to patients with R1 resection unable to undergo re-resection?

CheckMate 577 only included patients with R0 resection.For R1 resections, guidelines suggest observation vs re-resection only.

How do you manage unresectable esophageal cancer involving both the thoracic esophagus and GE junction?

In the case of multiple skip lesions in the thoracic esophagus and GE junction, the PTV may encompass nearly the entire esophagus, including the supra...

Would you recommend stent placement upfront in a patient with cervical esophageal cancer and a TE fistula?

Is it safe to treat a recurrent esophageal SCC with definitive chemoradiation after a prior endoscopic mucosal resection?

What is the risk of perforation / fistulization?

How do you manage a patient with gastric/GE junction carcinoma who has positive lymph nodes at resection after neoadjuvant chemotherapy?

If you would elect for adjuvant therapy, which study helps guide your choice of regimen?

What chemotherapy regimen do you recommend with radiation therapy for cervical esophageal squamous cell carcinoma?

The upfront plan is to use a definitive radiation dose of 66 Gy. My reading supports the use of 5FU + cisplatin but another doctor is recommending FOL...

For localized esophageal cancer in patients with preexisting neuropathy, what do you use concurrently with radiation therapy?

What is the added benefit of Chemo-RT vs RT alone?

What dose do you use for definitive treatment of squamous cell carcinoma of the cervical esophagus?

Let's re-open the debate!

In light of the 2015 ASTRO plenary session presentation about involved-field radiation vs elective nodal radiation therapy, are you including elective nodal fields (celiac, mediastinal, supraclavicular) in the treatment of locally advanced esophageal cancer?

How do you manage a patient who presents with a tracheoesophageal fistula from a lung or esophageal primary that is non-metastatic?

As a for instance, a centrally located primary tumor with mediastinal adenopathy that results in a TE fistula? Currently we would recommend esophagea...

4 Answers available

How do you manage unresctable thoracic esophageal cancer invading the trachea?

What chemotherapy and radiation doses/fractionation would you use once the airway has been stabilized to provide reasonably safe and effective palliat...

Would you consider PCI for a patient with neuroendocrine carcinoma of the esophagus?

Would you consider induction chemotherapy prior to starting chemoradiation therapy in squamous cell carcinoma of the esophagus?

If the patient has large, bulky nodes would you consider starting after chemotherapy for cytoreduction? Or otherwise consider replanning mid-treatment...

Would you consider maintenance therapy for patients who achieve complete response after palliative chemoradiation for metastatic distal esophageal adenocarcinoma?

If so, what regimen would you consider?

How would you manage dysphagia and odynophagia in an otherwise healthy patient with newly diagnosed metastatic esophageal cancer with a large primary in the mid to distal esophagus?

Would you send the patient for a stent or do palliative RT?

4 Answers available

For a GE junction tumor with a lymph node distant from the primary site, would the treatment volume be contiguous?

I.e. Would you treat most of the normal esophagus to include a mediastinal lymph node?

How do you contour distal esophageal cancer in the postop setting after Ivor-Lewis pT3N3 (perigastric and periesophageal LN)?

What regional lymph nodes do you include perigastric, portahepatic, periesophageal, celiac, splenic, pancreaticoduodenal, sup. mesenteric, paraesophag...

Should I use PET/CT for GE junction treatment planning?

We use PET for esophageal, but not gastric cancer. GE junction seems like a grey area.

Do you stage and treat GE junction tumors like gastric or esophageal cancer?

Does the advent of FLOT in gastric cancers, change your approach to GE adeno's? Would anyone consider FLOT followed by chemoradition followed by surge...