EGJ Adenocarcinoma: Hepatic and Peritoneal Recurrence After Multimodality Treatment

20 Feb 2024 05:00 06:30
Verona
Giovanni De Manzoni Host

Case 1: EGJ Adenocarcinoma With Solitary Liver Recurrence

Patient Profile & Initial Diagnosis

  • Patient: Male, 04/03/1970

  • Age: 50-year-old patient

  • Diagnosis: EGJ adenocarcinoma (Siewert II, cT3 N2 M0).

  • Initial Treatment: FLOT and Ivor-Lewis esophagectomy (MIE).

Histology Report

  • Pathological Stage: ypT2N1(1/71), R0.

  • Molecular / Pathology Findings: HER2 -, CMV -, PDL1 -, EBV -, MSS.

Recurrence & Treatment

  • Recurrence: Single liver metastasis of 2.5 cm in S8.

  • Systemic Treatment: FOLFOX (6+6).

  • Surgical Treatment: Laparoscopic hepatic metastasectomy.

  • Pathology: Pathology report confirmed hepatic localization of adenocarcinoma compatible with esophageal primitive nature.

  • Follow-up: Scan negative in May 2023 and October 2023.

Presenter of the Case

Dr. Carlo Alberto De Pasqual (AOUI Verona)

Case 2: EGJ Adenocarcinoma With Hepatic and Peritoneal Recurrence

Patient Profile & Initial Diagnosis

  • Patient: 62-year-old patient

  • Diagnosis: EGJ adenocarcinoma (Siewert II, cT3N1M0).

  • Initial Treatment: TCF + 50.4 Gy and Ivor-Lewis esophagectomy (MIE).

Final Pathology

  • Pathological Stage: ypT0N0, 0/42.

Hepatic Recurrence & Treatment

  • Recurrence: Two liver metastases.

  • Systemic Treatment: FOLFOX (12).

  • Surgical / Local Treatment: Robot-assisted hepatic metastasectomy (S6) and percutaneous thermoablation (S4a).

  • Histology: Histological examination confirmed hepatic localization of adenocarcinoma (MSS, PDL1- and HER2-, EBV-).

Peritoneal Recurrence

  • Recurrence: Pelvic recurrence three months later.

  • Exploratory Laparoscopy: Showed diffuse peritoneal carcinosis (PCI 38), and bilateral annexectomy was performed.

  • Histology: Histology report confirmed ovarian localization of adenocarcinoma compatible with gastroenteric origin.

Panel for Discussion

Maria Bencivenga (University of Verona) | Sara Lonardi (The Veneto Institute of Oncology IOV – IRCCS) | Bas Wijnhoven (University of Rotterdam) | Felix Berlth (University of Tuebingen)

Topics for Discussion

  1. EGJ adenocarcinoma (Siewert II)

  2. Peri-operative chemotherapy vs neoadjuvant chemo-radiotherapy

  3. Hepatic recurrence

  4. Peritoneal recurrence