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Hello. Looking for any input on this challenging case.
58 yo male, obese. neoadj chemo (carbo/taxol)-XRT (50.4 Gy total dose as 41.4 then boost gross disease) for cT3N0 GE junction adeno completed 7/2018. Ivor Lewis Esophagectomy 10/2018 with 4mm residual disease ypT1bN2 (4 nodes + out of 18 submitted).
1 year later (11/2019) on imaging he has a high level 4R mediastinal node look slightly larger. It is above his anastomosis (at carina) and above his prior radiation. It's hot on PET (no other sites of disease); EUS biopsy + for adeno, Her2 (-). He completes capecitabine/oxiliplatinum and new PET (3/2020) shows no new disease but not much if any response in the node.
Right now CT surgery says no mediastinal dissection (he had a VERY tough time with the esophagectomy, nearly died due to anastomotic leak, prolonged ICU stay/hospitalization).
Image below. Node touches esophagus but does not invade it.
Treat upper mediastinaum/SCLV then boost the node with xeloda? Consider radiosurgery (or a more ablative dose like 70 in 15 or something?)
58 yo male, obese. neoadj chemo (carbo/taxol)-XRT (50.4 Gy total dose as 41.4 then boost gross disease) for cT3N0 GE junction adeno completed 7/2018. Ivor Lewis Esophagectomy 10/2018 with 4mm residual disease ypT1bN2 (4 nodes + out of 18 submitted).
1 year later (11/2019) on imaging he has a high level 4R mediastinal node look slightly larger. It is above his anastomosis (at carina) and above his prior radiation. It's hot on PET (no other sites of disease); EUS biopsy + for adeno, Her2 (-). He completes capecitabine/oxiliplatinum and new PET (3/2020) shows no new disease but not much if any response in the node.
Right now CT surgery says no mediastinal dissection (he had a VERY tough time with the esophagectomy, nearly died due to anastomotic leak, prolonged ICU stay/hospitalization).
Image below. Node touches esophagus but does not invade it.
Treat upper mediastinaum/SCLV then boost the node with xeloda? Consider radiosurgery (or a more ablative dose like 70 in 15 or something?)
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