Esophageal cancer treatment options are based on observations of survival of cancer patients in different stages with their esophageal cancer. In the following table findings from several clinical trials were pooled.
It is a summary of the material from Ref. 1 and 2. Most patients were in cancer stage II or III. It is interesting to note that different treatment modalities resulted in different survival rates. As the table below shows, radiotherapy alone has a lower response rate than chemotherapy (with cisplatin and 5-Fluoruracil or others) followed by radiotherapy.
When surgery is added to chemotherapy or is added after pretreatment with chemotherapy and radiotherapy (last column), cure rates were improving again. This last approach is the best possible therapy that oncologists can offer.
Effect of various treatment modalities on esophageal cancer survival
| Years after treatment: | radiotherapy | chemo-Rx + radiotherapy | chemo- Rx + surgery | chemo-Rx + radiotherapy + surgery |
| 1 year | 35 % | 50 % | 65 % | |
| 2 years | 15 % | 38 % | 55 % | |
| 5 years |
5 % | 15 % | 31 % | 33 % |
It is usually reserved for patients with grade II, III and IV esophageal cancers that are considered robust enough to go through this combination procedure.
Not every patient will qualify after chemotherapy and radiotherapy for the surgical procedure that is supposed to remove as much cancer as possible. However, the observation from several clinical trials is that chemotherapy alone will often lead to initial response rates of 50% to 60%, but within a few months there is a cancer recurrence that eventually kills the patient within about 16 months. With additional radiotherapy and subsequent removal of the viable leftover cancer a significant cure rate can be achieved with 5-year survival rates in the 36% range and 10-year survivals of about 18%. However, these figures vary from Cancer Clinic to Cancer Clinic and are somewhat unreliable because of variations in the staging methods (Ref. 2).
References:
1. Cancer: Principles &Practice of Oncology.4th edition. Edited by Vincent T. DeVita, Jr. et al. Lippincott, Philadelphia,PA, 1993. Chapter 25. Cancer of the esophagus.
2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Cancer of the esophagus.
3. D Sharma J Indian Med Assoc 1999 Sep;97(9): 360-364.
4. MJ Roth et al. Cancer Res 2001 May 15;61(10):4098-4104.
5. K Schumacher et al. Cancer Res 2001 May 15;61(10):3932-3936.
6. M Tachibana et al. Virchows Arch 2001 Apr;438(4):350-356.
7. SJ Spechler et al. JAMA 2001 May 9;285(18):2331-2338.
