Esophagus

Question 1

Esophageal staging: tumor invades the lamina propria or muscularis mucosa

Answer 1

T1a

Question 2

Esophageal staging: Tumor invades the submucosa

Answer 2

T1b

Question 3

Esophageal staging: Tumor invades the muscularis propria

Answer 3

T2

Question 4

Esophageal staging: Tumor invades the adventitia

Answer 4

T3

Question 5

Esophageal staging: Tumor invades the pleura, pericardium, azygos vein, diaphragm, or peritoneum

Answer 5

T4a

Question 6

Esophageal staging: Tumor invades other adjacent structures, such as aorta, vertebral body or airway

Answer 6

T4b

Question 7

Esophageal staging: Metastasis in 1-2 regional lymph nodes

Answer 7

N1

Question 8

Esophageal staging: Metastasis in 3-6 regional lymph nodes

Answer 8

N2

Question 9

Esophageal staging: Metastasis in 7 or more regional lymph nodes

Answer 9

N3

Question 10

Esophageal contouring and expansions

Answer 10

GTV - gross disease on PET
CTV = GTV + 4 cm sup/inf, 1 cm radial, 0.5 cm on nodes and elective nodes (see ENI card)
PTV = CTV + 0.5 cm

Question 11

Esophageal ENI by site

Answer 11

Cervical - SCV and high depending on involved nodes
Proximal 1/3 - consider para-esophageal and SCV
Middle 1/3 - para-esophageal
GEJ/distal 1/3 - para-esophageal, lesser curvature, splenic, and celiac axis nodal regions

Question 12

Esophageal constraints: Lung V40, V20 and mean

Answer 12

V40 < 10 %
V20 < 20 %
Mean < 20 Gy

Question 13

Esophageal constraints: Heart V30 and mean

Answer 13

V30 < 30% (20% preferred)
Mean < 30 Gy (26 preferred)

Question 14

Esophageal constraints: Kidney separate evaluations V20 and mean

Answer 14

V20 Gy < 33%
Mean 18 Gy

Question 15

Esophageal constraints: Liver V30 and Mean

Answer 15

V30< 33%
Mean < 25 Gy

Question 16

Esophageal constraints: Stomach Mean and Max

Answer 16

Mean < 45 Gy
Max < 54 Gy

Question 17

Esophageal RT dosing

Answer 17

preop 41.4 Gy - 50.4 Gy
postop 45-50.4 Gy
definitive 50-50.4 Gy
in 1.8 - 2 Gy per fx

Question 18

Preferred Tx for adenocarcinoma T1b-2 N+ or T3-T4a any N or high risk T2N0

Answer 18

perioperative CT with FLOT unless medically unfit for surgery, or not a FLOT candidate

Question 19

Preferred Tx for SCC T1b-2 N+ or T3-T4a any N or high risk T2N0

Answer 19

Preoperative CRT

Question 20

What drugs are in FLOT

Answer 20

fluorouracil, leucovorin, oxaliplatin and docetaxel

Question 21

Esophagus SCC location criteria

Answer 21

Cervical - cricoid to thoracic inlet
Upper - thoracic inlet to lower border of azygos vein
Middle - lower border of azygos vein to lower border of inferior pulmonary vein
Lower - Lower border of pulmonary vein to stomach, including GEJ