GEJ Adenocarcinoma with Complete Response after QT - Is There a Role for Watchful Wait?

Authors:
Francisco MARRANA¹, Diogo MELO PINTO¹, Tatiana MOREIRA MARQUES¹, Tiago FIGUEIREDO RAMA¹


Affliations:
¹Department of General Surgery of Unidade Local de Saúde de Matosinhos, Portugal


Corresponding email address:
Francisco MARRANA (francisco.marrana@ulsm.min-saude.pt)

Abstract

The purpose of this poster is to enhance the role of pre-operative QT in GEJ adenocarcinomas and to reflect on the role of watchful waiting in this type of patient.

We present a case of a 66-year-old female patient with the diagnosis of GEJ adenocarcinoma. This patient underwent an upper endoscopy that revealed a polyp that was excised and confirmed as malignant from pathology. CT showed a distal esophageal lesion with no lymph node involvement.

It was decided to initiate a perioperative chemotherapy treatment with docetaxel, oxaliplatin, leucovorin, and 5-fluorouracil (FLOT). The patient was submitted to 4 cycles.

A new CT was performed where no lesion was identifiable whatsoever. The same result was obtained when a new upper endoscopy was performed, with no tumor visible.

A minimally invasive Ivor-Lewis esophagectomy was performed and the patient was discharged 11 days after.

The pathological exam showed a GEJ adenocarcinoma with an almost complete response and tumoral regression in muscularis propria and residual cancer cells in the submucosa. The patient resumed oncological therapies with FLOT and is now already eating a regular diet.

With this case, we intend to show the importance of perioperative QT in GEJ adenocarcinomas and even discuss the possibility of a watchful wait strategy in such patients, since the results of oncological treatments really pay off on their own.