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Personally, I don't take the nodes higher than the primary if genuinely treating definitively. That doesn't strike me as ethical. I don't do it in any other situation where I'm treating definitively. Unresectable nodes in neoadjuvant rectum, sure. I tell the patient up-front in definitive attempts that this probably won't cure you. Definitive chemorads works 100% of the time 20% of the time.Another question is at what point is nodal disease “incurable”
I recently was lead into chasing nodes down near into the pelvis.
Do I treat them to 50.4 or 60+? They aren’t coming out at surgery. So any other adeno we are going to boost these nodes as high as bowel tolerance will allow. That’s what I did. But we stop the primary at 50.4? Cause esophageal is special. Ok. Makes zero sense.