Esophageal cancer is second only to pancreatic cancer in its lethality, according to a 2011 study from Statistics Canada. Larry F. Ellison and colleagues reported that only 13 percent of esophageal cancer patients survive five years from diagnosis. Of those who reach the five-year mark, only 83 percent survive another five years.
Nicholas P. Campbell and Victoria M. Villaflor of The University of Chicago Pritzker School of Medicine, Chicago, Illinois, provided a review of treatment options. These authors noted that esophageal cancer is “the most rapidly increasing tumor type in the Western world,” with poor survival rates.
In the United States, the number of adenocarcinoma cancers of the esophagus increased by 350 percent between 1974 and 1994. This type is associated with obesity and gastroesophageal reflux disease (GERD), and now accounts for 60 percent of new esophageal cancer diagnoses. The other major type is squamous cell carcinoma, which is associated with tobacco and alcohol use.
Surgery alone is a standard treatment for esophageal cancer with sufficiently localized disease. Radiotherapy alone is standard for the 50 to 60 percent of cases for which surgery is not an option. Both radiation therapy and chemotherapy have been tried as adjuvant therapy in combination with surgery.
Theoretically, both radiation and chemotherapy can shrink tumors before surgery and improve the results. After surgery, radiation has potential to kill remaining cancer cells near the surgical site, while chemotherapy targets micrometastatic disease.
A number of small trials have evaluated the value of adding radiation therapy or chemotherapy to surgery. Overall, there appears to be a benefit, but it is small. “The optimal treatment strategy for resectable esophageal cancer is still a controversial topic,” Campbell and Villaflor concluded.
Stefano Cafarotti and colleagues at Catholic University, Rome, Italy, added, “there is no general consensus on the appropriate treatment for such a dreadful condition.” All authors recommended further research to guide physicians and patients.