chemo/radiation for post operative esophageal cancer.

[Paul__0]

  I have discussed my fathers case with you before. I thank you for your helpful replies. The following is a quick summary.
  1. My father is 74 years old. Operation performed June 29, 1998. Peformed a gastro esophagectomy. Post operative complications were minimal. Dad is eating almost normally again with no difficulty. He is exercising by way of a daily 1-2 mile walk. Overall weight loss has been marginal.
  2. Pathology report indicated that the tumor had been sucessfully resected. Proximal and distal regions were free of tumor. The tumor removed was 3 cm X 4 cm and was in to the adventitia, Adjacent tissue and organs were free of tumor. The sample removed did not have any regional lymph nodes attached to it. The surgeons post operative report states that he felt what he thought were 2 or 3 nodes during surgery and removed them. The pathology report confirms that there were no nodes removed. The surgeons opinion is that since he did not feel or see any other suspicious area's he feels the tumor has not advanced to the nearby nodes.
  3. The oncologist recommended by the surgeon and GI feels that it would be wise to perform local radiation [5 days per week for 6 weeks] and 6 sessions of chemo at 1 month intervals using carboplatinum and taxol. We took dad for a second opinion to Memorial Sloan Kettering {MSKCC} and were told that they did not agree with administering chemo and radiation. MSKCC has completed a study with some 400 patients and have concluded that adjuvant radiation and chemo does not affect the liklihood of reoccurence or metastasis after surgery. They were also confused as to why nodes were not removed during surgery. MSKCC recommended no futher chemo/radiation. They felt the best thing would be to scan very 3 months to check for reoccurence/spread. By the way, CT scan of the thorax and abdomen prior to surgery revealed no spreading either.
  Please answer the following:
  1. Is there a biological reason as to why nodes could not have been removed or missed by the surgeon?
  2. Based on the surgeons opinion, Can we correctly be certain that the lymph nodes are not affected?
  3. In your opinion would chemo/radiation as described above be more effective now as opposed to waiting using the MSKCC approach? I would have thought that the time to treat most effectively would be now when any remaining cancer cells would not be as numerous as they would down the road.
  4. If yes to question 3, Do you think carboplatitnum and taxol is the best agent to administer for Chemo? Most of my reading indicates that CDDP and 5FU is the standard for esophageal Cancer. When I asked the oncologist, he said that the standards were changing and would take time to make their way in to print.
  Please give me your best response to the above as I want to give my DAD the best chance.
  Thanks in advance
  Paul
Dear Paul,
I do not know of any biological reason of why lymph nodes were not removed during the surgery. As I mentioned in my
previous answers a lot of what happens in esophageal cancer surgery depends upon the expertise of the local surgeon. At some
point it boils down to a matter of trusting the surgeon who operated on your father. As you know, MSKCC is probably one of,
if not the best cancer facility in this country. I would certainly trust their opinion. However, if you still have reservations, I would
urge you to obtain the opinion of another oncologist. Good luck to you.
This response is for general informational purposes only and should not be considered medical advice or consultation. Always
check with your personal physician when you have a question pertaining to your health.
HFHSM.D.-ym
*Keywords: esophageal cancer