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Post-treatment management of esophageal cancers: Surgical considerations

Post-treatment management of esophageal cancers: Surgical considerations. Stephen Swisher, MD PhD Robert F. Fly Professor of Surgical Oncology Chairman, Department of Thoracic and Cardiovascular Surgery MD Anderson Cancer Center Houston, TX.

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Post-treatment management of esophageal cancers: Surgical considerations

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  1. Post-treatment management of esophageal cancers:Surgical considerations Stephen Swisher, MD PhD Robert F. Fly Professor of Surgical Oncology Chairman, Department of Thoracic and Cardiovascular Surgery MD Anderson Cancer Center Houston, TX

  2. Surgical Options for recurrent esophageal cancerStephen Swisher- 7 mins

  3. Surgical Options for recurrent esophageal cancerStephen Swisher- 7 mins Role of surgery for treatment of tumor recurrence after Esophagectomy (without chemoXRT) surgical options for recurrent tumor after primary esophagectomy Jejunum Colon

  4. Surgical Options for recurrent esophageal cancerStephen Swisher- 7 mins Role of surgery for treatment of tumor recurrence after Esophagectomy (without chemoXRT) surgical options for recurrent tumor after primary esophagectomy

  5. Surgical Options for recurrent esophageal cancerStephen Swisher- 7 mins Role of surgery for treatment of tumor recurrence after Esophagectomy (without chemoXRT) surgical options for recurrent tumor after primary esophagectomy

  6. Surgical Options for recurrent esophageal cancerStephen Swisher- 7 mins Role of surgery for treatment of tumor recurrence after Esophagectomy (without chemoXRT) surgical options for recurrent tumor after primary esophagectomy

  7. Surgical Options for recurrent esophageal cancerStephen Swisher- 7 mins Role of surgery for treatment of tumor recurrence after Esophagectomy (without chemoXRT) surgical options for recurrent tumor after primary esophagectomy

  8. Surgical Options for recurrent esophageal cancerStephen Swisher- 7 mins Role of surgery for treatment of tumor recurrence after Definitive chemoradiation Is surgery possible after chemoradiation What are potential risks and benefits

  9. Surgical Options for recurrent esophageal cancerStephen Swisher- 7 mins Role of surgery for treatment of tumor recurrence after Definitive chemoradiation Is surgery possible after chemoradiation What are potential risks and benefits

  10. Surgical Options for recurrent esophageal cancerStephen Swisher- 7 mins Role of surgery for treatment of tumor recurrence after Pre-op chemo-XRT- in patients who recur after an complete clinical response.

  11. Surgical Options for recurrent esophageal cancerStephen Swisher- 7 mins Role of surgery for treatment of tumor recurrence after Pre-op chemo-XRT- in patients who recur after an complete clinical response.

  12. Surgical Options for recurrent esophageal cancerStephen Swisher- 7 mins Role of surgery for treatment of tumor recurrence after Pre-op chemo-XRT- in patients who recur after an complete clinical response.

  13. Surgical Options for recurrent esophageal cancerStephen Swisher- 7 mins Role of surgery for treatment of tumor recurrence after chemoradiation Salvage esophagectomy What is it; Who are potential candidates; Survival benefit

  14. Surgical Options for recurrent esophageal cancerStephen Swisher- 7 mins Role of surgery for treatment of tumor recurrence after chemoradiation Salvage esophagectomy What is it; Who are potential candidates; Survival benefit

  15. Surgical Options for recurrent esophageal cancerStephen Swisher- 7 mins Role of surgery for treatment of tumor recurrence after chemoradiation Salvage esophagectomy What is it; Who are potential candidates; Survival benefit

  16. Surgical Options for recurrent esophageal cancerStephen Swisher- 7 mins Role of surgery for treatment of tumor recurrence after chemoradiation Salvage esophagectomy What is it; Who are potential candidates; Survival benefit RTOG 0246

  17. Surgical Options for recurrent esophageal cancerStephen Swisher- 7 mins Role of surgery for treatment of tumor recurrence after chemoradiation Salvage esophagectomy What is it; Who are potential candidates; Survival benefit

  18. Surgical Options for recurrent esophageal cancerStephen Swisher- 7 mins Role of surgery for treatment of tumor recurrence after chemoradiation Salvage esophagectomy What is it; Who are potential candidates; Survival benefit RTOG 0246

  19. Q1

  20. Repeat endoscopy 1 year after surgery to rule out residual Barrett’s or dysplasia No CT Scan, CXR or PET scan unless symptoms because of low likelihood of distant mets with T1N0, LVI negative

  21. Repeat endoscopy 1 year after surgery to rule out residual Barrett’s or dysplasia No CT Scan, CXR or PET scan unless symptoms because of low likelihood of distant mets with T1N0, LVI negative

  22. Q2

  23. Path CR – no diff. in relapse locations What we do: if no sxs - CT scan +/- EGD q6 mos x 4 then yrly (only asx group to help – LN, ? Anast Rec)

  24. Q3

  25. Salvage Esophagectomy no metastatic disease, regional LN no other curative Rx

  26. Q4

  27. Since unable to tolerate surgery few therapeutic options if Asymtomatic – PE q 6 months If symptomatic studies to assess for palliative Rx –Stents, EMR, PDT, Brachytherapy

  28. State of the Art

  29. Post treatment surveillance for esophageal cancer Summary of today’s state of the art Asymptomatic recurrences that can be helped : CT Scans +/- Endoscopy q 6 mos x 4 then q year Anastomotic Recurrence Salvage Surgery: Colonic/Jejunal conduit CRT Local/Distant LN Surgery or CRT (non-radiated area)

  30. Post treatment surveillance for esophageal cancer What new modalities are on the horizon in the next 5 years? the next 10 years? Novel Molecular Therapeutics PET Scan identification of non-responders to allow additional treatment prior to resection

  31. Post treatment surveillance for esophageal cancer

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