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Hello! I have a case for you and looking forward to hearing your input.
Male patient in his sixties, known history of tobacco use. Now presents with swallowing difficulties and is diagnosed with a cT3 G3 SCC of the thoracic esophagus.
No immediate regional nodes affected, but two findings on PET-CT: one node in the uppermost mediastinum (almost SCV) and a few other nodes grouped together in the coeliac region. The first biopsy of the tumor was negative and compliance was an issue, so it took some time to complete workup. A new CT done 6 weeks after the PET-CT shows the nodes growing in size, but no apparent new nodes. Swallowing has also worsened.
According to the new staging system, these nodes are still regional, so it's a cT3 cN2 cM0.
However, back in the old days this node metastatic pattern would have classified as cM1a, if I am not mistaken.
Anyways, the nodes lie more than 30cm apart. So with a traditional volume including ENI one would irradiate the full length of the esophagus to include all the nodes between the primary and those two metastatic nodes sites. On the other hand, one does not have to do ENI and could simply leave a gap in between.
I am not sure if definite radiochemotherapy is the right answer here, chances of cure are small due to the node pattern and toxicity is going to be an issue, especially with ENI.
Your thoughts? The surgeons do not want to operate. The patient seems cisplatin-eligible.
Male patient in his sixties, known history of tobacco use. Now presents with swallowing difficulties and is diagnosed with a cT3 G3 SCC of the thoracic esophagus.
No immediate regional nodes affected, but two findings on PET-CT: one node in the uppermost mediastinum (almost SCV) and a few other nodes grouped together in the coeliac region. The first biopsy of the tumor was negative and compliance was an issue, so it took some time to complete workup. A new CT done 6 weeks after the PET-CT shows the nodes growing in size, but no apparent new nodes. Swallowing has also worsened.
According to the new staging system, these nodes are still regional, so it's a cT3 cN2 cM0.
However, back in the old days this node metastatic pattern would have classified as cM1a, if I am not mistaken.
Anyways, the nodes lie more than 30cm apart. So with a traditional volume including ENI one would irradiate the full length of the esophagus to include all the nodes between the primary and those two metastatic nodes sites. On the other hand, one does not have to do ENI and could simply leave a gap in between.
I am not sure if definite radiochemotherapy is the right answer here, chances of cure are small due to the node pattern and toxicity is going to be an issue, especially with ENI.
Your thoughts? The surgeons do not want to operate. The patient seems cisplatin-eligible.
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