Would you treat the supraclavicular nodes electively for a patient with esophageal adenocarcinoma originating in the mid-esophagus but extending above the carina?

Yes, a surgical series using Sclav LN dissection for thoracic esophageal ca showed a 15% Sclav LN +ve rate in mid lesions. Without a contraindication, and assuming patient risk is even higher given extension above carina, I would electively include.

Agreed. This would be a regional node and lymph node. Mets are common at an extended distance from an esophageal primary. I’d add that if the patient has access to a facility with protons I’d strongly consider referring. The benefit may be increased as the volume of thorax, mediastinum, and upper GI...