Locally Advanced Esophageal Squamous Cell Carcinoma: Neoadjuvant Immunotherapy, Chemotherapy and Surgery

29 Oct 2020 02:10 02:10
Beijing
Jie He Host
You-Sheng Mao Host

Case 1: Locally Advanced Middle Thoracic Squamous Cell Carcinoma

Initial Diagnosis & Treatment

  • Diagnosis: A locally advanced esophageal middle thoracic squamous cell carcinoma with metastatic lymph nodes in the right recurrent nerve area.

  • Clinical Stage: cT3N1M0 Stage III AJCC.

  • Neoadjuvant Therapy: 4 cycles of neoadjuvant immunotherapy combined with chemotherapy were applied.

  • Adverse Events: No adverse events.

Surgery

  • Procedure: Minimally invasive McKeown esophagectomy with two-field lymphadenomectomy.

  • Timing: Surgery performed 4 weeks after neoadjuvant therapy.

  • Final Pathological Diagnosis: ypT0N0M0.

Discussion Points

  • Value of additional PD-1 blockade

  • Neoadjuvant therapy

  • Combined immunotherapy

  • Evaluation of clinical response to treatment

  • Indications for surgery in patients with clinically complete response

Case 2: Locally Advanced Middle Thoracic Squamous Cell Carcinoma With Poor Response to Chemoradiotherapy

Initial Diagnosis & Treatment

  • Diagnosis: A potentially resectable locally advanced middle thoracic squamous cell carcinoma.

  • Clinical Stage: cT3N1M0 Stage III AJCC.

  • Neoadjuvant Chemoradiotherapy: 2 cycles + 40 Gy.

  • Treatment Response: Poor response with tumor progression.

Sequential Treatment

  • Therapy: Sequential chemotherapy combined with immunotherapy.

  • Response: Significant response.

Surgery

  • Procedure: Minimally invasive esophagectomy with radical tumor resection.

  • Timing: Surgery performed 4 weeks after sequential chemotherapy combined with immunotherapy.

  • Final Pathological Diagnosis: ypT1bN0M0.

  • Outcome: Sudden death of unknown cause.

Discussion Points

  • Neoadjuvant therapy for locally advanced tumors

  • Strategy for patients with poor response to chemoradiotherapy

  • Indications for combined immunotherapy

  • Indications for surgery in such patients

  • Preferable surgical techniques after complex neoadjuvant therapy