Esophageal Cancer   

Will you change your surveillance interval? Old et al., PMID 40180292

Would you switch to concurrent chemoradiation or continue FLOT as per ESOPEC protocol?

Would you continue with RT as planned?

Additionally, would you consider prophylactic stent placement and/or gastrostomy in anticipation of a fistula?

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

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...

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...

Tumor is PD-L1 positive and HER2 positive

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

Would you offer adjuvant nivolumab?

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

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...

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

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

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

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

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...

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

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

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

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

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...

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

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

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 ...

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

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

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

What factors would influence your approach?

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

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

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...

What is the risk of perforation / fistulization?

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

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...

Liver and skeletal metastasis with no disease in the lung.

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

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

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

Let's re-open the debate!

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

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

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

If so, what regimen would you consider?

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

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

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

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

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...