Esophageal Cancer Medical Slides
Generate publication-quality esophageal cancer lecture slides in 30 seconds. AI-powered content structured for clinical education.
Generate Esophageal Cancer DeckWhy teach Esophageal Cancer?
Esophageal cancer is the eighth most common cancer and sixth leading cause of cancer death worldwide. Adenocarcinoma (linked to Barrett esophagus and GERD) has overtaken squamous cell carcinoma in Western countries. The CROSS trial (2012) established neoadjuvant chemoradiation followed by esophagectomy as the standard of care for locally advanced disease. The TIME trial and MIRO trial validated minimally invasive approaches, and immunotherapy with nivolumab after neoadjuvant chemoradiation (CheckMate 577) has further improved outcomes.
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Esophageal Cancer Presentation FAQ
How should the CROSS trial and its long-term data be presented?
Present the CROSS trial (2012, NEJM): 368 patients with resectable esophageal/GEJ cancer randomized to neoadjuvant chemoradiation (carboplatin AUC2 + paclitaxel 50 mg/m² weekly × 5 + 41.4 Gy in 23 fractions) followed by surgery versus surgery alone. Results: R0 resection rate 92% vs 69%, pathologic complete response 29%, median OS 49 vs 24 months. 10-year follow-up (2021): OS 38% vs 25%, benefit sustained across histologies but more pronounced in squamous cell carcinoma (10-year OS 46% vs 23%) than adenocarcinoma (36% vs 27%). This established neoadjuvant chemoradiation as standard for cT1b-T3/N0-3/M0 esophageal cancer.
What surgical approach selection criteria should be taught?
Present the three approaches: Ivor Lewis (transthoracic — right thoracotomy + laparotomy): preferred for distal esophageal/GEJ tumors, allows formal thoracic lymphadenectomy, intrathoracic anastomosis (leak rate 5-15%). McKeown (three-field — right thoracotomy + laparotomy + cervical anastomosis): for mid/upper esophageal tumors, cervical anastomosis is safer if leaks occur (drains externally, lower mediastinitis risk), but higher stricture and recurrent laryngeal nerve injury rates. Transhiatal (no thoracotomy): avoids thoracotomy morbidity, cervical anastomosis, but limited mediastinal lymphadenectomy. MIRO trial: hybrid MIE (laparoscopic abdomen + open thoracotomy) reduced pulmonary complications vs open. TIME trial: fully MIE reduced in-hospital pulmonary infections (12% vs 34%).
How should CheckMate 577 adjuvant immunotherapy be covered?
Present CheckMate 577 (2021, NEJM): patients with esophageal/GEJ cancer who had neoadjuvant chemoradiation + surgery but did NOT achieve pathologic complete response (i.e., residual disease, ypT1-4 or ypN+) randomized to nivolumab 240 mg q2w × 16 weeks then 480 mg q4w (total 1 year) versus placebo. Disease-free survival doubled: median 22.4 months vs 11.0 months (HR 0.69). Benefit seen in both adenocarcinoma and squamous cell carcinoma, regardless of PD-L1 status. This established adjuvant nivolumab as standard of care for the 70-75% of CROSS-treated patients who do not achieve pCR. Monitor for immune-related adverse events (colitis, pneumonitis, hepatitis, thyroiditis).
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