Would you offer local therapy to a patient with GEJ adenocarcinoma with FDG-avid para-aortic node oligometastasis?

For nodes just inferior to the celiac/SMA axis and no other distant metastatic disease? Stage is formally M1, but just barely. The patient is otherwise reasonably healthy and in their 50s. Would you proceed with chemoRT +/- surgery?

Answer from: Radiation Oncologist at Community Practice

I have favored induction systemic therapy and interval re-assessment. If responsive or at least stable disease, I have offered extended field CRT as long as the treatment volume seems reasonable and my perception is that it would be tolerable when assessed in the context of a patient’s perform...

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Radiation Oncologist at Ashland Radiation Oncology, Inc.
I have a > 30-year-old male with distal esophag...

Radiation Oncologist at Mayo Clinic School of Medicine
As a general “rule of thumb”, I strong...

Answer from: Radiation Oncologist at Academic Institution

I agree with Dr. @Krishan R. Jethwa. We would typically start with 3-6 months of systemic therapy. This is less advanced disease than oligometastatic disease, and so I think it is appropriate to be aggressive. I haven't found that this particularly drives up toxicity, as that seems much more heavily...

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Radiation Oncologist at West Virginia University
Although it is compelling to think that induction ...

Radiation Oncologist at Vanderbilt-Ingram Cancer Center
Retrospective data seems to point to yes, although...

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Would you offer local therapy to a patient with GEJ adenocarcinoma with FDG-avid para-aortic node oligometastasis?

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