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...

Which patients with localized esophageal adenocarcinoma, if any, would you offer nivolumab after lack of pCR to neoadjuvant FLOT?

What is your second line therapy for PDL1 negative metastatic squamous esophageal cancer who did not receive a checkpoint inhibitor in first line setting?

Would you use nivolumab or a taxane? Is the data from the ATTRACTION-3 trial with an all-Asian patient population applicable to practice to the US pop...

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...

How long would you continue trastuzumab for a patient with metastatic HER2+ esophageal adenocarcinoma whose tumor has achieved CR with FOLFOX + trastuzumab and has been disease-free for nearly 3 years?

How would you manage a cT4N0 HER2- distal esophageal adenocarcinoma, CPS score 30, with good response to neoadjuvant chemo-RT on PET and residual disease on EGD in a patient who declines surgery?

Would you offer adjuvant nivolumab?

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?

How do you dose FOLFOX when given with concurrent chemoradiation in esophageal adenocarcinoma?

Would you only give three cycles with radiation, or are you adding two more cycles of FOLFOX afterwards?

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?

In patient with upper esophageal SCC who had partial response to neoadjuvant chemoradiation but deemed not to be a surgical candidate, would you recommend chemotherapy or nivolumab?

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

What initial systemic approach will you recommend for metastatic pMMR HER2-positive esophageal/GEJ/gastric adenocarcinoma with PDL1 of 0?

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

Would you consider adjuvant nivolumab to be the standard of care in stage II/III esophageal/GE junction cancer after completion of neoadjuvant chemoradiotherapy and surgery?

Based on CheckMate 577?Is DFS endpoint sufficient to establish SOC or is OS benefit needed?

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...

Do you test your esophageal and gastric specimens for HER2 using IHC, FISH, or both?

What other molecular tests do you routinely order on such tumors?

5 Answers available

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?

How do you initially treat patients with cN3 cM0 esophageal cancer?

Do you proceed with chemotherapy alone, neoadjuvant chemoRT, or definitive chemoRT? How do you communicate treatment intent to the patient?

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...

Would you consider giving FLOT entirely in the neoadjuvant setting for resectable gastric cancer?

If so, how many cycles would you give? Both the MAGIC and FLOT trials showed difficulty with administering adjuvant chemotherapy.

When planning to give adjuvant nivolumab for esophageal cancer, would you be comfortable with nivolumab with q4 weekly dosing as opposed to q2 weekly dosing?

Do you routinely obtain CPS assay to assess candidacy for chemoimmunotherapy in newly diagnosed metastatic esophageal/GEJ/gastric adenocarcinoma?

Is it necessary to test CPS given the FDA approvals are not contingent on CPS %? If you do test, do you check 28-8 (nivolumab), 22C3 (pembroliz...

What first line regimen for metastatic esophageal or GEJ adenocarcinoma would you use in an elderly patient (>80) with medical comorbidities?

Would you use reduced dose chemoimmunotherapy, single agent chemotherapy, or single agent immunotherapy if the patient is unlikely to tolerate full do...

What initial systemic approach will you recommend for metastatic pMMR HER2- esophageal/GEJ/gastric adenocarcinoma with CPS of 0-4?

Do you view CPS < 1% or 1-4% separately? Do you view the incremental benefit of adding immunotherapy still advantageous given relatively poor outco...

What impacts your decisions regarding the use of immunotherapy in metastatic G/E/GEJ cancers overall in light of variations in FDA approval, guidelines, and trial data?

Do you go by FDA approval alone, or incorporate other data into your treatment decisions? How do you view updated recent presentation of CM-649 ...

What are your considerations for choice of immunotherapy agent with patients with metastatic pMMR HER2- esophageal/GEJ/gastric adenocarcinoma with CPS >=10?

Are there meaningful differences in the CHECKMATE 649 and KEYNOTE 590 studies to guide this decision?

Based on KEYNOTE-811, would you add pembrolizumab for HER2+ distal esophageal adenocarcinoma with new supraclavicular lymph nodes if treated previously with concurrent chemoradiation and PD-L1 CPS of 3?

Would you recommend nivo/ipi instead of chemotherapy/nivo or chemotherapy alone in advanced squamous esophageal cancer based on Checkmate 648?

0 Answers available

For a patient with distal esophageal adenocarcinoma with residual disease after FOLFOX x3 cycles + RT followed by surgery, would you recommend adjuvant chemotherapy or adjuvant nivolumab?

Would you ever consider adjuvant chemotherapy rather than adjuvant immunotherapy after the publication of the CM-577 results? If so, in which pop...

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?

How do you manage HER2+ metastatic esophageal cancer in frail and elderly patients?

How does use of adjuvant nivolumab impact your subsequent use of immunotherapy + chemo in a PDL1+ GEJ cancer with metastatic relapse?

What factors would influence your approach?

Should we be giving adjuvant nivolumab to all eligible esophageal/GEJ cancer, irrespective of the PD-L1 status of the tumor?

Are there other treatment variations by clinical subsets (eg tumor location, histology, stage II vs III, other biomarkers) seen in CM577 or other data...

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?

Is celiac lymph node involvement a contraindication for chemoradiaton in esophageal adenocarcinoma?

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...

Would you consider adding atezolizumab to chemotherapy for metastatic esophageal small cell cancer?

Liver and skeletal metastasis with no disease in the lung.

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?

For patients with distal esophageal adenocarcinoma who are not surgical candidates, how do you decide between the preferred chemotherapy regimens when given as definitive chemo-radiation?

Preferred options in NCCN guidelines: 5FU+cisplatin, 5FU+oxaliplatin, paclitaxel+carboplatin?

Do you use trastuzumab for patients with localized HER2+ esophageal cancer after definitive chemoRT who are not surgical candidates?

Do you utilize it immediately following chemoRT or wait until disease progression?

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...

How do you manage postoperative residual disease after neoadjuvant chemoradiotherapy and surgery for a patient with locally advanced esophageal or GE junction adenocarcinoma?

0 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?

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...