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12 - Management of cancer of the oesophagus

Published online by Cambridge University Press:  05 November 2015

Carys Morgan
Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
Tom Crosby
Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
Louise Hanna
Velindre Cancer Centre, Velindre Hospital, Cardiff
Tom Crosby
Velindre Cancer Centre, Velindre Hospital, Cardiff
Fergus Macbeth
Velindre Cancer Centre, Velindre Hospital, Cardiff
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In the past few decades there has been a dramatic increase in the incidence of adenocarcinoma of the oesophagus, predominantly in the lower oesophagus and gastro-oesophageal junction. This trend has been noted across most patient populations worldwide, but is most noticeable in the younger, white male population, and it appears to be primarily with gastro-oesophageal reflux disease (GORD) and less strongly with alcohol and smoking. Meanwhile, the incidence of squamous cancer worldwide has remained steady or has fallen slightly, although there are large geographical variations.

The majority of patients have developed locally advanced or metastatic disease by the time they present with symptoms and this limits their survival from any treatment. Staging is increasingly more accurate with the routine use of positron emission tomography (PET) and endoscopic ultrasound (EUS) enabling those with advanced disease to be excluded from more intensive treatment options, thus avoiding unnecessary adverse effects on the quality of life.

Combined modality therapy is increasingly used in patients who are suitable for curative treatment. There is evidence that preoperative chemotherapy is superior to surgery alone. There is a continuing controversy about the exact role of surgery combined with chemoradiotherapy (CRT) and which modality should be used first. To date it has not been possible to recruit to a comparative clinical trial.

It is known that CRT is more effective than radiotherapy alone and there is now clear evidence of the effectiveness of definitive chemoradiotherapy (dCRT) in oesophageal cancers. dCRT should therefore be considered a treatment option for selected patients such as those who are unfit for surgery, whose local disease extent precludes surgery or those with squamous cancers.

Optimum radiotherapy and chemotherapy regimens are being defined in the preoperative and definitive setting. Despite this, the majority of patients still present with advanced incurable disease where treatment options are more limited, but palliative chemotherapy has a role in some cases.

Early assessment of response to treatment is becoming an area of interest with early PET scans currently being incorporated into several trial protocols.

Types of oesophageal tumour

The types of oesophageal tumours are shown in Table 12.1.

The oesophagus is a relatively common site for a second primary cancer. For instance, following successful treatment for head and neck cancer, 4% of patients per year develop a second primary, 30% of which are oesophageal, especially squamous cancers.

Publisher: Cambridge University Press
Print publication year: 2015

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Alderson, D., Langley, R. E., Nankivell, M. G., et al. (2015). Neoadjuvant chemotherapy for resectable oesophageal and junctional adenocarcinoma: results from the UK Medical Research Council randomised OE05 trial (ISRCTN 01852072). J. Clin. Oncol., 33, 2015 (suppl; abstr 4002).
Bang, Y-J., Van Cutsem, E., Feyereislova, A., et al. (2010). Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet, 376, 687–697.CrossRefGoogle ScholarPubMed
Bates, B. A., Detterbeck, F. C., Bernard, S. A., et al. (1996). Concurrent radiation therapy and chemotherapy followed by esophagectomy for localized esophageal carcinoma. J. Clin. Oncol., 14, 156–163.CrossRefGoogle ScholarPubMed
Bedenne, L., Michel, P., Bouche, O., et al. (2007). Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J. Clin. Oncol., 25, 1160–1168.CrossRefGoogle ScholarPubMed
Blazeby, J., Farndon, J., Donovan, J., et al. (2000). A prospective longitudinal study examining the quality of life of patients with esophageal carcinoma. Cancer, 88, 1781–1787.3.0.CO;2-G>CrossRefGoogle ScholarPubMed
Bosset, J. F., Gignoux, M., Triboulet, J. P., et al. (1997). Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N. Engl. J. Med., 337, 161–167.CrossRefGoogle ScholarPubMed
Cooper, J. S., Guo, M. D., Herskovic, A., et al. (1999). Chemoradiotherapy of locally advanced esophageal cancer: long term follow-up of a prospective randomized trial (RTOG 85–01). J. Am. Med. Ass., 281, 1623–1627.CrossRefGoogle Scholar
Crosby, T., Hurt, C. N., Falk, S., et al. (2013). Chemoradiotherapy with or without cetuximab in patients with oesophageal cancer (SCOPE1): a multicentre, phase 2/3 randomised trialLancet Oncol., 14, 627–637.CrossRefGoogle ScholarPubMed
Cunningham, D., Allum, W. H., Stenning, S. P., et al. (2006). Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N. Engl. J. Med., 355, 11–20.CrossRefGoogle ScholarPubMed
Cunningham, D., Starling, N., Rao, S., et al. (2008). Capecitabine and oxaliplatin for advanced esophagogastric cancer. N. Engl. J. Med. 358, 36–46.CrossRefGoogle ScholarPubMed
Earlam, R. and Cunha-Melo, J. R. (1980). Oesophageal squamous cell carcinoma: II. A critical view of radiotherapy. Br. J. Surg., 67, 457–461.Google Scholar
Ford, H. E., Marshall, A., Bridgewater, J. A., et al. (2014). Docetaxel versus active symptom control for refractory oesophagogastric adenocarcinoma (COUGAR-02): an open-label, phase 3 randomised controlled trial. Lancet Oncol., 15(1), 78–86.CrossRefGoogle ScholarPubMed
Gebski, V., Burmeister, B., Smithers, B. M., et al. (2007). Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol., 8(3), 226–234.CrossRefGoogle ScholarPubMed
Geh, J., Bond, S., Bentzen, S., et al. (2000). Preoperative chemoradiotherapy in esophageal cancer: evidence of dose response. Proc. Am. Soc. Clin. Oncol., abstr. 958.Google Scholar
Kelsen, D. P., Ginsberg, R., Pajak, T. F., et al. (1998). Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N. Engl. J. Med., 339, 1979–1984.CrossRefGoogle ScholarPubMed
Luketich, J. D., Schauer, P. R., Meltzer, C. C., et al. (1997). Role of positron emission tomography in staging esophageal cancer. Ann. Thoracic. Surg., 64, 765–769.CrossRefGoogle ScholarPubMed
Medical Research Council Oesophageal Cancer Working Group. (2002). Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet, 359, 1727–1733.
Minsky, B. D., Pajak, T. F., Ginsberg, R. J., et al. (2002). INT 0123 (Radiation Therapy Oncology Group 94–05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J. Clin. Oncol., 20, 1167–1174.CrossRefGoogle ScholarPubMed
Ohtsu, A., Shah, M. A.,Van Cutsem, E., et al. (2011). Bevacizumab in combination with chemotherapy as first-line therapy in advanced gastric cancer: a randomized, double-blind, placebo-controlled phase III study. J. Clin. Oncol., 29, 3968–3976.CrossRefGoogle ScholarPubMed
O'Neill, J. R., Stephens, N. A., Save, V., et al. (2013). Defining a positive circumferential resection margin in oesophageal cancer and its implications for adjuvant treatment. Br. J. Surg., 100, 1055–1063.CrossRefGoogle ScholarPubMed
Reid, T. D., Chan, D. S., Roberts, S. A., et al. (2012). Prognostic significance of circumferential resection margin involvement following oesophagectomy for cancer and the predictive role of endoluminal ultrasonography. Br. J. Cancer, 107, 1925–1931.CrossRefGoogle ScholarPubMed
Sjoquist, K. M., Burmeister, B. H., Smithers, B. M., et al. (2011). Australasian Gastro-Intestinal Trials Group (2011). Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol., 12, 681–692.CrossRefGoogle ScholarPubMed
Stahl, M., Wilke, H., Fink, U., et al. (1996). Combined preoperative chemotherapy and radiotherapy in patients with locally advanced esophageal cancer: Interim analysis of phase II trial. J. Clin. Oncol., 14, 829–837.CrossRefGoogle ScholarPubMed
Sykes, A. J., Burt, P. A., Slevin, N. J., et al. (1998). Radical radiotherapy for carcinoma of the oesophagus: an effective alternative to surgery. Radiother. Oncol., 48, 15–21.CrossRefGoogle Scholar
UICC. (2009). In TNM Classification of Malignant Tumours, ed. Sobin, L. H., Gospodarowicz, M. K and Wittekind, Ch., 7th edn. New York: Wiley-Liss, pp. 66–72.
Urba, S. G., Orringer, M. B., Turrisi, A., et al. (2001). Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J. Clin. Oncol., 19, 305–313.CrossRefGoogle ScholarPubMed
van Hagen, P., Hulshof, M. C., van Lanschot, J. J., et al. (2012). Preoperative chemoradiotherapy for esophageal or junctional cancer. N. Engl. J. Med., 366, 2074–2084.CrossRefGoogle ScholarPubMed
Vogt, K., Fenlon, D., Rhodes, S., et al. (2006). Preoperative chemotherapy for resectable thoracic esophageal cancer (Cochrane Review). In The Cochrane Library, Issue 7. Oxford: Update Software.Google Scholar
Waddell, T., Chau, I., Cunningham, D., et al. (2013). Epirubicin, oxaliplatin, and capecitabine with or without panitumumab for patients with previously untreated advanced oesophagogastric cancer (REAL3): a randomised, open-label phase 3 trial. Lancet Oncol., 14, 481–489.CrossRefGoogle ScholarPubMed
Walsh, T., Noonan, N., Hollywood, D., et al. (1996). A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N. Engl. J. Med., 335, 462–467.CrossRefGoogle ScholarPubMed
Wong, R. and Malthaner, R. (2005). Combined chemotherapy and radiotherapy (without surgery) compared with radiotherapy alone in localized carcinoma of the esophagus (Cochrane Review). In The Cochrane Library, Issue 2. Oxford: Update Software.Google Scholar

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