In a patient with a mid-esophageal squamous cell carcinoma with tracheal invasion confirmed on bronchoscopy, would you treat with definitive chemo-radiation with curative intent?
Additionally, would you consider prophylactic stent placement and/or gastrostomy in anticipation of a fistula?
Answer from: Radiation Oncologist at Community Practice
I generally start with chemotherapy alone in these patients, usually carbo/taxol for 2-3 months, and then re-evaluate with PET, bronchoscopy, and endoscopy to determine if there is still evidence of transmural invasion into the trachea. Often, if the tumor responds, the tracheal invasion is no longe...
Answer from: Radiation Oncologist at Academic Institution
Curative-intent chemoradiation can be technically challenging for a mid-esophageal squamous cell carcinoma with tracheal invasion due to the risk of creating or worsening a tracheoesophageal fistula during treatment. Whether I would treat a patient with a mid-esophageal squamous cell carcinoma with ...
Answer from: Radiation Oncologist at Community Practice
This is a palliative case. Symptoms not revealed. Stents offer patency of respective tubes and can be applied when symptoms warrant. At MUSC, we randomized such patients to palliative XRT, vs Nytenol metallic stent. Final data held by Boston Scientific; never published. Stent provided the ability to...
Answer from: Medical Oncologist at Community Practice
For locally advanced squamous cell carcinoma of the esophagus preoperative chemoradiation followed by surgery, or definitive chemoradiation with close surveillance and salvage surgery for local tumor persistence or progression can be considered (Obermannová et al., PMID 35914638). Definitive ...
Comments
Radiation Oncologist at Mon Health Thanks, very helpful and practical.