Esophageal Cancer CME – Experience from a Regional Cancer Centre

Moderator: Dr Tracy Irura

Speakers & Topics:

• Dr Omar Abdihamid: Evolving Landscape of Esophageal Cancer Treatment
• Dr Abdullahi Hadi: Optimising Diagnosis of Esophageal Cancer
• Dr Mohamed Noor: Surgical Approaches to Esophageal Cancer

Dr. Noor Mohamed provided a historical evolution of esophageal cancer surgery from Czerny’s resection to modern minimally invasive techniques.
– Surgical resection remains critical, especially for early-stage and select advanced cases after neoadjuvant therapy.
– Key considerations include thorough staging (OGD, PET-CT, EUS), patient optimization (nutrition, glycemic control), and perioperative care.
– Outcomes from global surgical databases: R0 resection rates up to 93%, 30- and 90-day mortality rates at 2% and 4.5% respectively.
– Challenges in Kenya include late presentation, limited access to ICU care, and lack of trained personnel.
– Trials such as CROSS, PreSANO, and SANO are shaping modern surveillance versus resection decisions in select cases.

Dr. Omar Abdihamid – emphasized that most patients in Kenya present with locally advanced disease; male/female incidence is similar.
– Immunotherapy has shifted paradigms: CheckMate 648 showed improved OS with nivolumab + chemotherapy or ipilimumab.
– CROSS and ESOPEC trials guide perioperative regimens (carbo/taxol RT → surgery → nivolumab vs FLOT-based therapy).
– Early-stage SCC may be treated with endoscopic resection if well-differentiated, superficial, and no lymphovascular invasion.
– Radiotherapy regimens tailored by location: cervical tumors dose-escalated up to 60Gy; others typically 50.4Gy.
– Garissa Cancer Centre approach includes advanced IMRT planning, with regional data contributing to genomic and QoL research.
– SANO trial supports non-inferiority of active surveillance post-chemoradiotherapy, showing similar OS to surgery and better QoL.