Q) A 65-year-old male presents with grade IV dysphagia and is diagnosed with squamous cell carcinoma of the upper third of the esophagus. What is the most appropriate next step in management?
a) Definitive chemoradiotherapy b) Neoadjuvant chemotherapy followed by transhiatal esophagectomy c) Systemic chemotherapy alone d) Neoadjuvant chemoradiotherapy followed by three-field esophagectomy
✅ Correct answer: a) Definitive chemoradiotherapy
💡 Explanation:
Upper third esophageal squamous cell carcinoma poses a challenge for surgical resection due to its proximity to the pharynx and larynx.
In resectable upper esophageal SCC, especially in older patients or when the tumor is very proximal, definitive chemoradiotherapy (CRT) is often the preferred treatment to avoid morbid surgery like laryngopharyngoesophagectomy.
Multiple guidelines, including NCCN and ESMO, recommend definitive CRT for upper esophageal SCC unless there’s a compelling reason for surgery.
❌ Why other options are incorrect:
b) Neoadjuvant chemo + THE: THE (transhiatal esophagectomy) is not suitable for upper esophageal tumors. It doesn't provide good access to cervical/upper thoracic esophagus.
c) Chemotherapy alone: Not standard. Chemotherapy without radiation is inadequate for curative intent in localized esophageal cancer.
d) Neoadjuvant CRT + three-field esophagectomy: Though this is an option for mid/lower third esophageal cancers, especially in younger patients, it's more morbid and rarely used for upper third SCC in older patients.
