Cancer of the Esophagus: Combined Radiation Therapy, Chemotherapy, and Surgery
Treatment for cancer of the esophagus, the tube that connects the throat to the stomach, usually includes surgery, sometimes in combination with chemotherapy and/or radiation therapy. In cases of advanced disease, the goal of treatment is to relieve symptoms of disease, prolong survival time, and enhance quality of life. Researchers continue to study which therapies used with surgery, and in what sequence (before or after surgery), are most effective. In cases in which surgery is not possible, radiation therapy and/or chemotherapy may be used alone or in combination. Recently, researchers at Yale University found that the survival time of persons with cancer of the esophagus was prolonged using a low-dose chemotherapy plus radiation therapy, followed by surgery, and then additional chemotherapy with paclitaxel. This is an important finding because, in the past, the use of chemotherapy and radiation therapy before surgery has been shown to increase surgery-related deaths.
Forty-two persons with esophageal cancer underwent special procedures, called endoscopic ultrasound and laparoscopy, to carefully determine the stage of their disease (extent of disease at diagnosis) before treatment. Overall, the stages ranged from stage II to stage IV disease, with 50% having stage III disease and 12% having stage IV. All persons received low doses of chemotherapy with radiation therapy. Of these 42, 39 persons underwent surgery to remove the esophagus. After surgery, the patients received a chemotherapy regimen, including a drug called paclitaxel. The results showed that 29 persons (26%) responded to the treatment given before surgery, 11 of whom had a complete response. For 18 persons, the cancer had shrunk to less than its size at diagnosis. For 5 persons, no change was observed, and for 8 persons, the disease continued to grow. In persons who had a complete response to the treatment before surgery, 91% were alive after 2 years. In persons who did not have a complete response before surgery, 51% were alive after 2 years. Overall, 62% of persons were alive after 2 years. Only 1 person died of surgery-related complications.
These researchers concluded that the advantages observed with this treatment over other pre-surgery regimens may be due to the low doses of chemotherapy that were used as well as to the paclitaxel that was administered after surgery. They noted that it is particularly impressive that 51% of persons who did not even have complete responses to the pre-surgery treatment, and many with advanced stages of disease, were alive after 2 years. Persons who have cancer of the esophagus may wish to talk with their doctor about the risks and benefits of this treatment regimen, or of participating in a clinical trial in which other new treatments are being studied. (Journal of Clinical Oncology, Vol 18, No 4, pp 868-876, 2000)
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