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 supraclavicular and celiac nodal regions. If a patient cannot undergo surgery, can this large volume be safely treated with chemoradiation? Would you decrease the dose to your initial field to below 4140cGy to meet normal tissue constraints? Does the histology of SCC or adenocarcinoma change your recommendation?
Answer from: Radiation Oncologist at Academic Institution
I agree with @Charles R. Thomas. Assuming the patient is a candidate for concurrent chemoradiation, I would attempt to treat the grossly involved tumor and nodes to 50.4Gy since there is no other potentially curative therapy. If the field is very large (encompassing all or nearly all of the esophagu...
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Answer from: Radiation Oncologist at Academic Institution
We need to remember that RTOG-8501 treated the entire esophagus for the initial fields, so treating a large field is not unheard of. With modern day treatment planning and delivery, it would be reasonable to treat definitely to treat the entire CTV (defined as the esophagus and nodes) to 45 Gy and ...
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Radiation Oncologist at Naval Medical Center San Diego
What lung constraints do you recommend when treati...
What lung constraints do you recommend when treati...
Radiation Oncologist at Mon Health
If standard dose constraints could be met, what ar...
If standard dose constraints could be met, what ar...
Answer from: Radiation Oncologist at Community Practice
I agree with both @Charles R. Thomas and @Abraham J. Wu. Intentionally avoiding portions of the esophagus in between areas of gross disease would undertreat any microscopic occult disease. Plus treatment of the entire esophagus to ~45 Gy is better tolerated better than you might thi...