Long-Term Survival With Salvage Surgery for Recurrent Esophageal Adenocarcinoma After Chemoradiotherapy

The patient is an 80-year-old man with a newly diagnosed gastroesophageal junction adenocarcinoma, whose comorbidities include coronary artery disease, percutaneous coronary intervention 3 years earlier without recurrence of chest pain, and well-controlled diabetes. He is otherwise healthy and lives independently with his elderly wife. Baseline staging by [F-18] fluorodeoxyglucose-positron emission tomography (PET)/computed tomography (CT) scan and endoscopic ultrasound reveal a uT3N0 tumor without evidence of metastasis. He is treated with induction carboplatin plus paclitaxel, and repeat PET/CT scan demonstrates > 35% decrease in maximum standardized uptake value of the primary tumor. He then receives concurrent chemoradiation with carboplatin plus paclitaxel to a total of 50.4 Gy. Repeat PET/CT reveals complete resolution of prior abnormal [F-18] fluorodeoxyglucose uptake, and endoscopy indicates only mild mucosal irregularity at the site of the prior tumor, biopsy of which is negative for cancer. The patient is concerned about the risks of surgery and wishes to avoid it if possible. He returns to discuss further management.