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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65900_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65900_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65900_"><span class="title" itemprop="name">Esophageal Cancer Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Health Professional Version</div><p class="contrib-group"><span itemprop="author">PDQ Adult Treatment Editorial Board</span>.</p><p class="small">Published online: July 8, 2015.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062741__325">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of esophageal cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.</p><p id="CDR0000062741__326">This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p></div><div id="CDR0000062741__1"><h2 id="_CDR0000062741__1_">General Information About Esophageal Cancer</h2><div id="CDR0000062741__184"><h3>Incidence and Mortality</h3><p id="CDR0000062741__116">Estimated new cases and deaths from esophageal cancer in the United States in 2015:[<a class="bk_pop" href="#CDR0000062741_rl_1_1">1</a>]</p><ul id="CDR0000062741__117"><li class="half_rhythm"><div>New cases: 16,980.</div></li><li class="half_rhythm"><div>Deaths: 15,590.</div></li></ul><p id="CDR0000062741__3">The incidence of esophageal cancer has risen in recent decades, coinciding with
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a shift in histologic type and primary tumor location.[<a class="bk_pop" href="#CDR0000062741_rl_1_2">2</a>,<a class="bk_pop" href="#CDR0000062741_rl_1_3">3</a>] Adenocarcinoma of
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the esophagus is now more prevalent than squamous cell carcinoma in the United
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States and western Europe, with most tumors located in the distal esophagus.
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The cause for the rising incidence and demographic alterations is unknown.
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</p></div><div id="CDR0000062741__243"><h3>Risk Factors and Survival</h3><p id="CDR0000062741__5">While risk factors for squamous cell carcinoma of the esophagus have been
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identified (e.g., tobacco, alcohol, diet), the risk factors associated with
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esophageal adenocarcinoma are less clear.[<a class="bk_pop" href="#CDR0000062741_rl_1_3">3</a>] The presence of Barrett
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|
esophagus is associated with an increased risk of developing adenocarcinoma of
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|
the esophagus, and chronic reflux is considered the predominant cause of
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Barrett metaplasia. The results of a population-based, case-controlled study
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from Sweden strongly suggest that symptomatic gastroesophageal reflux is a risk
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factor for esophageal adenocarcinoma. The frequency, severity, and duration of
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reflux symptoms were positively correlated with increased risk of esophageal
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adenocarcinoma.[<a class="bk_pop" href="#CDR0000062741_rl_1_4">4</a>]
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|
</p><p id="CDR0000062741__6">Esophageal cancer is a treatable disease, but it is rarely curable. The overall
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|
5-year survival rate in patients amenable to definitive treatment ranges from 5% to 30%.
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|
The occasional patient with very early disease has a better chance of survival.
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|
Patients with severe dysplasia in distal esophageal Barrett mucosa often have
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<i>in situ</i> or even invasive cancer within the dysplastic area. Following
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|
resection, these patients usually have excellent prognoses.
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</p></div><div id="CDR0000062741__244"><h3>Treatment Modalities</h3><p id="CDR0000062741__7">Primary treatment modalities include surgery alone or chemotherapy with
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radiation therapy. Combined modality therapy (i.e., chemotherapy plus surgery, or
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chemotherapy and radiation therapy plus surgery) is under clinical evaluation.
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Effective palliation may be obtained in individual cases with various
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combinations of surgery, chemotherapy, radiation therapy, stents,[<a class="bk_pop" href="#CDR0000062741_rl_1_5">5</a>] and endoscopic therapy with Nd:YAG laser.[<a class="bk_pop" href="#CDR0000062741_rl_1_6">6</a>]
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</p></div><div id="CDR0000062741__245"><h3>Diagnostics for Staging</h3><p id="CDR0000062741__8">One of the major difficulties in allocating and comparing treatment modalities
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for patients with esophageal cancer is the lack of precise preoperative
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staging. Standard noninvasive staging modalities include computed tomography
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(CT) of the chest and abdomen and endoscopic ultrasound (EUS). The overall
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tumor depth staging accuracy of EUS is 85% to 90%, as compared with 50% to 80%
|
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for CT; the accuracy of regional nodal staging is 70% to 80% for EUS and 50% to
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70% for CT.[<a class="bk_pop" href="#CDR0000062741_rl_1_7">7</a>,<a class="bk_pop" href="#CDR0000062741_rl_1_8">8</a>] EUS-guided fine-needle aspiration (FNA) for lymph node
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staging is under prospective evaluation; one retrospective series reported a
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93% sensitivity and 100% specificity of regional nodal staging with EUS-FNA.[<a class="bk_pop" href="#CDR0000062741_rl_1_9">9</a>] Thoracoscopy and
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laparoscopy have been used in esophageal cancer staging at some surgical
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centers.[<a class="bk_pop" href="#CDR0000062741_rl_1_10">10</a>-<a class="bk_pop" href="#CDR0000062741_rl_1_12">12</a>] An intergroup trial reported an increase in positive lymph node detection to 56% of 107 evaluable patients using thoracoscopy/laparoscopy, from 41% (using noninvasive staging tests, e.g., CT, magnetic resonance imaging, EUS) with no major complications or deaths.[<a class="bk_pop" href="#CDR0000062741_rl_1_13">13</a>] Noninvasive positron emission tomography using the
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radiolabeled glucose analog 18-F-fluorodeoxy-D-glucose for preoperative
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staging of esophageal cancer is under clinical evaluation and may be useful in
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detecting stage IV disease.[<a class="bk_pop" href="#CDR0000062741_rl_1_14">14</a>-<a class="bk_pop" href="#CDR0000062741_rl_1_17">17</a>]
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</p><div id="CDR0000062741__246"><h4>Other tumors of the esophagus</h4><p id="CDR0000062741__4">Gastrointestinal stromal tumors can occur in the esophagus and are usually
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benign. (Refer to the PDQ summary on <a href="/books/n/pdqcis/CDR0000639481/">Gastrointestinal Stromal Tumors Treatment</a> for
|
|
more information.)
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</p></div></div><div id="CDR0000062741__197"><h3>Related Summaries</h3><p id="CDR0000062741__198">Other PDQ summaries containing information related to esophageal cancer include the following:</p><ul id="CDR0000062741__199"><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000062880/">Esophageal Cancer Prevention</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000062877/">Esophageal Cancer Screening</a></div></li></ul></div><div id="CDR0000062741_rl_1"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062741_rl_1_1">American Cancer Society: Cancer Facts and Figures 2015. Atlanta, Ga: American Cancer Society, 2015. <a href="http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed July 1, 2015.</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_2">Devesa SS, Blot WJ, Fraumeni JF Jr: Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 83 (10): 2049-53, 1998. [<a href="https://pubmed.ncbi.nlm.nih.gov/9827707" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9827707</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_3">Blot WJ, McLaughlin JK: The changing epidemiology of esophageal cancer. Semin Oncol 26 (5 Suppl 15): 2-8, 1999. [<a href="https://pubmed.ncbi.nlm.nih.gov/10566604" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10566604</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_4">Lagergren J, Bergström R, Lindgren A, et al.: Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 340 (11): 825-31, 1999. [<a href="https://pubmed.ncbi.nlm.nih.gov/10080844" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10080844</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_5">Tietjen TG, Pasricha PJ, Kalloo AN: Management of malignant esophageal stricture with esophageal dilation and esophageal stents. Gastrointest Endosc Clin N Am 4 (4): 851-62, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/7529118" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7529118</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_6">Bourke MJ, Hope RL, Chu G, et al.: Laser palliation of inoperable malignant dysphagia: initial and at death. Gastrointest Endosc 43 (1): 29-32, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8903814" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8903814</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_7">Ziegler K, Sanft C, Zeitz M, et al.: Evaluation of endosonography in TN staging of oesophageal cancer. Gut 32 (1): 16-20, 1991. [<a href="/pmc/articles/PMC1379206/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1379206</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/1991632" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1991632</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_8">Tio TL, Coene PP, den Hartog Jager FC, et al.: Preoperative TNM classification of esophageal carcinoma by endosonography. Hepatogastroenterology 37 (4): 376-81, 1990. [<a href="https://pubmed.ncbi.nlm.nih.gov/2210603" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2210603</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_9">Vazquez-Sequeiros E, Norton ID, Clain JE, et al.: Impact of EUS-guided fine-needle aspiration on lymph node staging in patients with esophageal carcinoma. Gastrointest Endosc 53 (7): 751-7, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11375583" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11375583</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_10">Bonavina L, Incarbone R, Lattuada E, et al.: Preoperative laparoscopy in management of patients with carcinoma of the esophagus and of the esophagogastric junction. J Surg Oncol 65 (3): 171-4, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9236925" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9236925</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_11">Sugarbaker DJ, Jaklitsch MT, Liptay MJ: Thoracoscopic staging and surgical therapy for esophageal cancer. Chest 107 (6 Suppl): 218S-223S, 1995. [<a href="https://pubmed.ncbi.nlm.nih.gov/7781397" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7781397</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_12">Luketich JD, Schauer P, Landreneau R, et al.: Minimally invasive surgical staging is superior to endoscopic ultrasound in detecting lymph node metastases in esophageal cancer. J Thorac Cardiovasc Surg 114 (5): 817-21; discussion 821-3, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9375612" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9375612</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_13">Krasna MJ, Reed CE, Nedzwiecki D, et al.: CALGB 9380: a prospective trial of the feasibility of thoracoscopy/laparoscopy in staging esophageal cancer. Ann Thorac Surg 71 (4): 1073-9, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11308139" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11308139</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_14">Flamen P, Lerut A, Van Cutsem E, et al.: Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma. J Clin Oncol 18 (18): 3202-10, 2000. [<a href="https://pubmed.ncbi.nlm.nih.gov/10986052" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10986052</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_15">Flamen P, Van Cutsem E, Lerut A, et al.: Positron emission tomography for assessment of the response to induction radiochemotherapy in locally advanced oesophageal cancer. Ann Oncol 13 (3): 361-8, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/11996465" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11996465</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_16">Weber WA, Ott K, Becker K, et al.: Prediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging. J Clin Oncol 19 (12): 3058-65, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11408502" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11408502</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_17">van Westreenen HL, Westerterp M, Bossuyt PM, et al.: Systematic review of the staging performance of 18F-fluorodeoxyglucose positron emission tomography in esophageal cancer. J Clin Oncol 22 (18): 3805-12, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/15365078" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15365078</span></a>]</div></li></ol></div></div><div id="CDR0000062741__9"><h2 id="_CDR0000062741__9_">Cellular Classification of Esophageal Cancer</h2><p id="CDR0000062741__10">Fewer than 50% of esophageal cancers are squamous cell carcinomas.
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Adenocarcinomas, typically arising in Barrett esophagus, account for at least
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50% of malignant lesions, and the incidence of this histology appears to be
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rising. Barrett esophagus contains glandular epithelium cephalad to the
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esophagogastric junction. </p><h4><span class="title">Three different types of glandular epithelium can be
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seen:</span></h4><ul id="CDR0000062741__96"><li class="half_rhythm"><div>Metaplastic columnar epithelium.</div></li><li class="half_rhythm"><div>Metaplastic parietal cell glandular
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epithelium within the esophageal wall.</div></li><li class="half_rhythm"><div>Metaplastic intestinal epithelium
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with typical goblet cells.</div></li></ul><p id="CDR0000062741__98">Dysplasia is particularly likely to develop in the
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intestinal type mucosa.
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</p><p id="CDR0000062741__11">Gastrointestinal stromal tumors can occur in the esophagus and are usually
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benign. (Refer to the PDQ summary on <a href="/books/n/pdqcis/CDR0000639481/">Gastrointestinal Stromal Tumors Treatment</a> for
|
|
more information.)
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</p></div><div id="CDR0000062741__12"><h2 id="_CDR0000062741__12_">Stage Information for Esophageal Cancer</h2><p id="CDR0000062741__13">The stage determines whether the intent of the therapeutic approach will be
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curative or palliative.
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</p><div id="CDR0000062741__186"><h3>Definitions of TNM</h3><p id="CDR0000062741__200">The AJCC has
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designated staging by TNM classification to define cancer of the esophagus and esophagogastric junction.[<a class="bk_pop" href="#CDR0000062741_rl_12_1">1</a>]</p><div id="CDR0000062741__159" class="table"><h3><span class="title">Table 1. Primary Tumor (T)<sup>a,b</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65900.1/table/CDR0000062741__159/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062741__159_lrgtbl__"><table class="no_margin"><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;">TX</td><td colspan="1" rowspan="1" style="vertical-align:top;">Primary tumor cannot be assessed.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T0</td><td colspan="1" rowspan="1" style="vertical-align:top;">No evidence of primary tumor.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Tis</td><td colspan="1" rowspan="1" style="vertical-align:top;">High-grade dysplasia.<sup>c</sup></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T1</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor invades lamina propria, muscularis mucosae, or submucosa.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T1a</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor invades lamina propria or muscularis mucosae.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T1b</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor invades submucosa.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T2</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor invades muscularis propria.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T3</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor invades adventitia.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T4</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor invades adjacent structures.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T4a</td><td colspan="1" rowspan="1" style="vertical-align:top;">Resectable tumor invading pleura, pericardium, or diaphragm.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T4b</td><td colspan="1" rowspan="1" style="vertical-align:top;">Unresectable tumor invading other adjacent structures, such as aorta, vertebral body, trachea, etc.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 103-15.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>b</sup>(1) At least maximal dimension of the tumor must be recorded, and (2) multiple tumors require the T(m) suffix.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>c</sup>High-grade dysplasia includes all noninvasive neoplastic epithelia that was formerly called carcinoma <i>in situ</i>, a diagnosis that is no longer used for columnar mucosae anywhere in the gastrointestinal tract. </p></div></dd></dl></div></div></div><div id="CDR0000062741__154" class="table"><h3><span class="title">Table 2. Regional Lymph Nodes (N)<sup>a,</sup><sup>b</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65900.1/table/CDR0000062741__154/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062741__154_lrgtbl__"><table class="no_margin"><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;">NX</td><td colspan="1" rowspan="1" style="vertical-align:top;">Regional lymph nodes cannot be assessed.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1</td><td colspan="1" rowspan="1" style="vertical-align:top;">Metastases in 1–2 regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N2</td><td colspan="1" rowspan="1" style="vertical-align:top;">Metastases in 3–6 regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N3</td><td colspan="1" rowspan="1" style="vertical-align:top;">Metastases in ≥7 regional lymph nodes.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 103-15.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>b</sup>Number must be recorded for total number of regional nodes sampled and total number of reported nodes with metastasis.</p></div></dd></dl></div></div></div><div id="CDR0000062741__155" class="table"><h3><span class="title">Table 3. Distant Metastasis (M)<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65900.1/table/CDR0000062741__155/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062741__155_lrgtbl__"><table class="no_margin"><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M1</td><td colspan="1" rowspan="1" style="vertical-align:top;">Distant metastasis.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 103-15.</p></div></dd></dl></div></div></div><div id="CDR0000062741__320" class="table"><h3><span class="title">Table 4. Anatomic Stage/Prognostic Groups<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65900.1/table/CDR0000062741__320/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062741__320_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="6" rowspan="1" style="text-align:left;vertical-align:top;"><i>Squamous Cell Carcinoma</i><sup>b</sup></th></tr></thead><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;"><b>Stage</b>
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</td><td colspan="1" rowspan="1" style="vertical-align:top;"><b>T</b></td><td colspan="1" rowspan="1" style="vertical-align:top;"><b>N</b></td><td colspan="1" rowspan="1" style="vertical-align:top;"><b>M</b></td><td colspan="1" rowspan="1" style="vertical-align:top;"><b>Grade</b></td><td colspan="1" rowspan="1" style="vertical-align:top;"><b>Tumor Location<sup>c</sup></b></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">0</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tis (HGD)</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">1, X</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">IA</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">1, X</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td></tr><tr><td colspan="1" rowspan="2" style="vertical-align:top;">IB</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">2–3</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T2–3</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">1, X</td><td colspan="1" rowspan="1" style="vertical-align:top;">Lower, X</td></tr><tr><td colspan="1" rowspan="2" style="vertical-align:top;">IIA</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2–3</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">1, X</td><td colspan="1" rowspan="1" style="vertical-align:top;">Upper, middle</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T2–3</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">2–3</td><td colspan="1" rowspan="1" style="vertical-align:top;">Lower, X</td></tr><tr><td colspan="1" rowspan="2" style="vertical-align:top;">IIB</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2–3</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">2–3</td><td colspan="1" rowspan="1" style="vertical-align:top;">Upper, middle</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T1–2</td><td colspan="1" rowspan="1" style="vertical-align:top;">N1</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td></tr><tr><td colspan="1" rowspan="3" style="vertical-align:top;">IIIA</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1–2</td><td colspan="1" rowspan="1" style="vertical-align:top;">N2</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T3</td><td colspan="1" rowspan="1" style="vertical-align:top;">N1</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T4a</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">IIIB</td><td colspan="1" rowspan="1" style="vertical-align:top;">T3</td><td colspan="1" rowspan="1" style="vertical-align:top;">N2</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td></tr><tr><td colspan="1" rowspan="3" style="vertical-align:top;">IIIC</td><td colspan="1" rowspan="1" style="vertical-align:top;">T4a</td><td colspan="1" rowspan="1" style="vertical-align:top;">N1–2</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T4b</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">N3</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">IV</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">M1</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any</td></tr><tr><td colspan="6" rowspan="1" style="text-align:left;vertical-align:top;"><i><b>Adenocarcinoma</b></i></td></tr><tr><td colspan="2" rowspan="1" style="text-align:center;vertical-align:top;"><b>Stage</b></td><td colspan="1" rowspan="1" style="text-align:center;vertical-align:top;"><b>T</b></td><td colspan="1" rowspan="1" style="text-align:center;vertical-align:top;"><b>N</b></td><td colspan="1" rowspan="1" style="text-align:center;vertical-align:top;"><b>M</b></td><td colspan="1" rowspan="1" style="text-align:center;vertical-align:top;"><b>Grade</b></td></tr><tr><td colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">Tis (HGD)</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">1, X</td></tr><tr><td colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">IA</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">T1</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">1–2, X</td></tr><tr><td colspan="2" rowspan="2" style="text-align:left;vertical-align:top;">IB</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">T1</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">3</td></tr><tr><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">T2</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">1–2, X</td></tr><tr><td colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">IIA</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">T2</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">3</td></tr><tr><td colspan="2" rowspan="2" style="text-align:left;vertical-align:top;">IIB</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">T3</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">Any</td></tr><tr><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">T1–2</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">N1</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">Any</td></tr><tr><td colspan="2" rowspan="3" style="text-align:left;vertical-align:top;">IIIA</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">T1–2</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">N2</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">Any</td></tr><tr><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">T3</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">N1</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">Any</td></tr><tr><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">T4a</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">Any</td></tr><tr><td colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">IIIB</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">T3</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">N2</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">Any</td></tr><tr><td colspan="2" rowspan="3" style="text-align:left;vertical-align:top;">IIIC</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">T4a</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">N1–2</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">Any</td></tr><tr><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">T4b</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">Any</td></tr><tr><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">N3</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">Any</td></tr><tr><td colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">IV</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">M1</td><td colspan="1" rowspan="1" style="text-align:left;vertical-align:top;">Any</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">HGD = high-grade dysplasia.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 103-15.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>b</sup>Or mixed histology, including a squamous component or not otherwise specified.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>c</sup>Location of the primary cancer site is defined by the position of the upper (proximal) edge of the tumor in the esophagus.</p></div></dd></dl></div></div></div><p id="CDR0000062741__205">The current staging system for esophageal cancer is based largely on
|
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retrospective data from the Japanese Committee for Registration of Esophageal
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Carcinoma. It is most applicable to patients with squamous cell carcinomas of
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the upper third and middle third of the esophagus, as opposed to the increasingly
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common distal esophageal and gastroesophageal junction adenocarcinomas.[<a class="bk_pop" href="#CDR0000062741_rl_12_2">2</a>] In
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particular, the classification of involved abdominal lymph nodes as M1 disease
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has been criticized. The presence of positive abdominal lymph nodes does not
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|
appear to carry as grave a prognosis as metastases to distant organs.[<a class="bk_pop" href="#CDR0000062741_rl_12_3">3</a>]
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Patients with regional and/or celiac axis lymphadenopathy should not
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necessarily be considered to have unresectable disease caused by metastases.
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Complete resection of the primary tumor and appropriate lymphadenectomy should
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be attempted when possible.
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</p></div><div id="CDR0000062741_rl_12"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062741_rl_12_1">Esophagus and esophagogastric junction. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 103-11.</div></li><li><div class="bk_ref" id="CDR0000062741_rl_12_2">Iizuka T, Isono K, Kakegawa T, et al.: Parameters linked to ten-year survival in Japan of resected esophageal carcinoma. Japanese Committee for Registration of Esophageal Carcinoma Cases. Chest 96 (5): 1005-11, 1989. [<a href="https://pubmed.ncbi.nlm.nih.gov/2805827" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2805827</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_12_3">Korst RJ, Rusch VW, Venkatraman E, et al.: Proposed revision of the staging classification for esophageal cancer. J Thorac Cardiovasc Surg 115 (3): 660-69; discussion 669-70, 1998. [<a href="https://pubmed.ncbi.nlm.nih.gov/9535455" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9535455</span></a>]</div></li></ol></div></div><div id="CDR0000062741__44"><h2 id="_CDR0000062741__44_">Treatment Option Overview for Esophageal Cancer</h2><p id="CDR0000062741__45">The prevalence of Barrett metaplasia in adenocarcinoma of the esophagus
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suggests that Barrett esophagus is a premalignant condition. Strong
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consideration should be given to resection in patients with high-grade
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dysplasia in the setting of Barrett metaplasia. Endoscopic surveillance of
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patients with Barrett metaplasia may detect adenocarcinoma at an earlier
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stage more amenable to curative resection.[<a class="bk_pop" href="#CDR0000062741_rl_44_1">1</a>] The survival rate of patients
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with esophageal cancer is poor. Asymptomatic small tumors confined to the
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esophageal mucosa or submucosa are detected only by chance. Surgery is the
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treatment of choice for these small tumors. Once symptoms are present
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(e.g., dysphagia, in most cases), esophageal cancers have usually invaded
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the muscularis propria or beyond and may have metastasized to lymph nodes or
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other organs.
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</p><p id="CDR0000062741__46">In the presence of complete esophageal obstruction without clinical evidence
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of systemic metastasis, surgical excision of the tumor with mobilization of the
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stomach to replace the esophagus has been the traditional means of relieving
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the dysphagia. In the United States, the median age of patients who present
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with esophageal cancer is 67 years.[<a class="bk_pop" href="#CDR0000062741_rl_44_2">2</a>] The results of a retrospective
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review of 505 consecutive patients who were operated on by a single surgical
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team over 17 years found no difference in the perioperative mortality, median
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survival, or palliative benefit of esophagectomy on dysphagia when the group of
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patients older than 70 years were compared to their younger peers.[<a class="bk_pop" href="#CDR0000062741_rl_44_3">3</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335144/" class="def">Levels of
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|
evidence: 3iiA</a> and <a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335145/" class="def"> 3iiB</a>] All of the patients in this series were selected for
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surgery on the basis of potential operative risk. Age alone should not determine
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therapy for patients with potentially resectable disease.
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</p><p id="CDR0000062741__47">The optimal surgical procedure is controversial. One approach
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advocates transhiatal esophagectomy with anastomosis of the stomach to the
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cervical esophagus. A second approach advocates abdominal mobilization of the
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stomach and transthoracic excision of the esophagus with anastomosis of the
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stomach to the upper thoracic esophagus or the cervical esophagus. One study concluded that transhiatal esophagectomy was associated with lower morbidity than transthoracic esophagectomy with extended en bloc lymphadenectomy; however, median overall disease-free and quality-adjusted survival did not differ significantly.[<a class="bk_pop" href="#CDR0000062741_rl_44_4">4</a>] Similarly, no differences in long-term quality of life (QOL) using validated QOL instruments have been reported.[<a class="bk_pop" href="#CDR0000062741_rl_44_5">5</a>] In patients
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with partial esophageal obstruction, dysphagia may, at times, be relieved by
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placement of an expandable metallic stent [<a class="bk_pop" href="#CDR0000062741_rl_44_6">6</a>] or by radiation therapy if the
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patient has disseminated disease or is not a candidate for surgery.
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Alternative methods of relieving dysphagia have been reported, including laser
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therapy and electrocoagulation to destroy intraluminal tumor.[<a class="bk_pop" href="#CDR0000062741_rl_44_7">7</a>-<a class="bk_pop" href="#CDR0000062741_rl_44_10">10</a>]
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</p><p id="CDR0000062741__48">Surgical treatment of resectable esophageal cancers results in 5-year survival
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rates of 5% to 30%, with higher survival rates in patients with early-stage
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cancers. This is associated with a less than 10% operative mortality rate.[<a class="bk_pop" href="#CDR0000062741_rl_44_11">11</a>]
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In an attempt to avoid this perioperative mortality and to relieve dysphagia,
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definitive radiation therapy in combination with chemotherapy has been studied.
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A Radiation Therapy Oncology Group randomized trial (RTOG-8501) of chemotherapy and radiation therapy versus radiation therapy
|
|
alone resulted in an improvement in 5-year survival for the combined modality
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|
group (27% vs. 0%).[<a class="bk_pop" href="#CDR0000062741_rl_44_12">12</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>] An eight-year follow-up of this trial
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|
demonstrated an overall survival (OS) rate of 22% for patients receiving
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chemoradiation therapy.[<a class="bk_pop" href="#CDR0000062741_rl_44_12">12</a>] An Eastern Cooperative Oncology Group trial (EST-1282) of 135
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patients showed that chemotherapy plus radiation provided a better 2-year
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survival rate than radiation therapy alone,[<a class="bk_pop" href="#CDR0000062741_rl_44_13">13</a>] which was similar to that shown in the
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Intergroup trial.[<a class="bk_pop" href="#CDR0000062741_rl_44_12">12</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>] In an attempt to improve upon the results
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of RTOG-8501, Intergroup-0123 <a href="http://cancer.gov/clinicaltrials/search/view?version=healthprofessional&cdrid=64043" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">(RTOG-9405) </a> randomly assigned 236 patients with
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localized esophageal tumors to chemoradiation with high-dose radiation therapy
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(64.8 Gy) and four monthly cycles of fluorouracil (5-FU) and cisplatin versus conventional-dose radiation therapy (50.4 Gy) and the same chemotherapy schedule.[<a class="bk_pop" href="#CDR0000062741_rl_44_14">14</a>]
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Although originally designed to accrue 298 patients, this trial was closed in 1999 after a planned interim analysis showed that it was statistically unlikely that there would be any advantage to using high-dose radiation. At 2 years' median follow-up, no statistical differences were observed between the high-dose and
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conventional-dose radiation therapy arms in median survival (13 months vs.
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18 months), 2-year survival (31% vs. 40%), or local/regional failures (56%
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vs. 52%).[<a class="bk_pop" href="#CDR0000062741_rl_44_14">14</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>] </p><div id="CDR0000062741__212"><h3>Preoperative Chemoradiation Therapy</h3><p id="CDR0000062741__213">Chemoradiation followed by surgery is a standard treatment option for patients with stages IB, II, III, and IVA esophageal cancer, based on the results of several randomized trials.</p><p id="CDR0000062741__214">The ongoing CROSS study randomly assigned 366 patients with resectable esophageal or junctional cancers to receive either surgery alone or weekly administration of carboplatin (dose titrated to achieve an AUC [area under the curve] of 2 mg/mL/minute) and paclitaxel (50 mg/m<sup>2</sup> of BSA [body surface area]) and concurrent radiation therapy (41.4 Gy in 23 fractions) administered over 5 weeks.[<a class="bk_pop" href="#CDR0000062741_rl_44_15">15</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>] The majority of the patients enrolled in the study have adenocarcinoma (75%). </p><p id="CDR0000062741__215">With a median follow-up of 45 months, preoperative chemoradiation was found to improve median OS from 24 months in the surgery-alone group to 49.4 months (hazard ratio [HR], 0.657; 95% confidence interval [CI], 0.495–0.871, <i>P</i> = .003). Additionally, preoperative chemoradiation improved the rate of R0 resections (R0 is defined as complete resection with no tumor within 1 mm of resection margins, 92% vs. 69%, <i>P</i> < .001). A complete pathologic response was achieved in 29% of patients who underwent resection after chemoradiation therapy. Postoperative complications and in-hospital mortality were equivalent in both groups. The most common hematologic side effects in the chemoradiation group were leukopenia (6%) and neutropenia (2%). The most common nonhematologic side effects were anorexia (5%) and fatigue (3%).[<a class="bk_pop" href="#CDR0000062741_rl_44_15">15</a>] </p><p id="CDR0000062741__216">Other phase III trials have compared preoperative concurrent chemoradiation therapy to
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surgery alone for patients with esophageal cancer.[<a class="bk_pop" href="#CDR0000062741_rl_44_15">15</a>-<a class="bk_pop" href="#CDR0000062741_rl_44_19">19</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>] A multicenter
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prospective randomized trial in which preoperative combined chemotherapy
|
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(i.e., cisplatin) and radiation therapy (37 Gy in 3.7 Gy fractions) followed by
|
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surgery was compared to surgery alone in patients with squamous cell carcinoma
|
|
showed no improvement in OS and a significantly higher
|
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postoperative mortality (12% vs. 4%) in the combined modality arm.[<a class="bk_pop" href="#CDR0000062741_rl_44_16">16</a>] In
|
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patients with adenocarcinoma of the esophagus, a single-institution phase III
|
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trial demonstrated a modest survival benefit (16 months vs. 11 months) for
|
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patients treated with induction chemoradiation therapy consisting of 5-FU,
|
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cisplatin, and 40 Gy (2.67 Gy fractions) plus surgery over resection
|
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alone.[<a class="bk_pop" href="#CDR0000062741_rl_44_17">17</a>] A subsequent single-institution trial randomly assigned patients (75% with
|
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adenocarcinoma) to 5-FU, cisplatin, vinblastine, and radiation
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therapy (1.5 Gy twice daily to a total of 45 Gy) plus resection versus
|
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esophagectomy alone.[<a class="bk_pop" href="#CDR0000062741_rl_44_18">18</a>] At a median follow-up of more than 8 years, there was no
|
|
significant difference between the surgery alone and combined modality therapy
|
|
with respect to median survival (17.6 months vs. 16.9 months), OS (16% vs. 30% at 3 years), or disease-free survival (16% vs. 28%
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at 3 years). An Intergroup trial (CALGB-9781) planned to randomly assign 475 patients with resectable squamous cell or adenocarcinoma of the thoracic esophagus to treatment with preoperative chemoradiation therapy (5-FU, cisplatin, and 50.4 Gy) followed by esophagectomy and nodal dissection or surgery alone.[<a class="bk_pop" href="#CDR0000062741_rl_44_19">19</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>] The trial was closed as a result of poor patient accrual; however, the results of the 56 enrolled patients, with a median follow-up of 6 years, were reported. The median survival was 4.48 years (95% CI, 2.4 years to not estimable) for trimodality therapy versus 1.79 years (95% CI, 1.41–2.59 years) for surgery alone (<i>P</i> = .002), with 5-year OS of 39% (95% CI, 21%–57%) versus 16% (95% CI, 5%–33%) for trimodality therapy versus surgery alone. </p><p id="CDR0000062741__217">A phase III German trial also compared induction chemotherapy (three courses of bolus 5-FU, leucovorin, etoposide, and cisplatin) followed by chemoradiation therapy (cisplatin, etoposide, and 40 Gy) followed by surgery (arm A), or the same induction chemotherapy followed by chemoradiation therapy (at least 65 Gy) without surgery (arm B) for patients with T3 or T4 squamous cell carcinoma of the esophagus.[<a class="bk_pop" href="#CDR0000062741_rl_44_20">20</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>] OS was the primary outcome. The analysis of 172 eligible, randomly assigned patients showed that OS at 2 years was not statistically significantly different between the two treatment groups (arm A: 39.9%; 95% CI, 29.4%–50.4%; arm B: 35.4%; 95% CI, 25.2%–45.6%; log-rank test for equivalence with 0.15, <i>P</i> < .007). Local progression-free survival (PFS) was higher in the surgery group (2-year PFS, 64.3%; 95% CI, 52.1%–76.5%) than in the chemoradiation therapy group (2-year PFS, 40.7%; 95% CI, 28.9%–52.5%; HR for arm B vs. arm A, 2.1; 95% CI, 1.3–3.5; <i>P</i> < .003). Treatment-related mortality was higher in the surgery group compared with the chemoradiation therapy group (12.8% vs. 3.5%, respectively; <i>P</i> < .03).</p></div><div id="CDR0000062741__218"><h3>Preoperative Chemotherapy Alone</h3><p id="CDR0000062741__219">The effects of preoperative chemotherapy are being evaluated in randomized trials, as was done in the <a href="http://cancer.gov/clinicaltrials/search/view?version=healthprofessional&cdrid=570474" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCT00525785</a> trial.[<a class="bk_pop" href="#CDR0000062741_rl_44_21">21</a>,<a class="bk_pop" href="#CDR0000062741_rl_44_22">22</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>]. An Intergroup trial randomly assigned 440 patients with local and operable esophageal cancer of any cell type to three cycles of preoperative 5-fluorouracil (5-FU) and cisplatin followed by surgery and two additional cycles of chemotherapy versus surgery alone. After a median follow-up of 55 months, there were no significant differences between the chemotherapy/surgery and surgery-alone groups in median survival (14.9 months and 16.1 months, respectively) or 2-year survival (35% and 37%, respectively). The addition of chemotherapy did not increase the morbidity associated with surgery. The Medical Research Council Oesophageal Cancer Working Party randomly assigned 802 patients with resectable esophageal cancer also of any cell type to two cycles of preoperative 5-FU and cisplatin followed by surgery versus surgery alone. At a median follow-up of 37 months, median survival was significantly improved in the preoperative chemotherapy arm (16.8 months vs. 13.3 months with surgery alone; difference 3.5 months; 95% CI, 1–6.5 months), as was 2-year OS (43% and 34% respectively; difference 9%; 95% CI, 3–14 months). The interpretation of the results from both of these trials is challenging because T or N staging was not reported and prerandomization and radiation could be offered at the discretion of the treating oncologist. </p><p id="CDR0000062741__220">The Japanese Clinical Oncology Group randomly assigned 330 patients with clinical stage II or III, excluding T4, squamous cell carcinomas to receive either two cycles of preoperative cisplatin and 5-FU (fluorouracil) followed by surgery versus surgery followed by postoperative chemotherapy of the same regimen.[<a class="bk_pop" href="#CDR0000062741_rl_44_23">23</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335127/" class="def">Level of evidence: 1iiC</a>] A planned interim analysis was conducted after patient accrual, and although the primary endpoint of PFS was not met, there was a significant benefit in OS among patients treated with preoperative chemotherapy (<i>P</i> = .01). As a result of these findings, the Data and Safety Monitoring Committee recommended early publication. </p><p id="CDR0000062741__221">With a median follow-up of 61 months, the 5-year OS was 55% among patients treated with preoperative chemotherapy compared with 43% among patients treated with postoperative chemotherapy (<i>P</i> = .04). However, there was no significant difference between groups with respect to PFS (5-year PFS, 39% vs. 44%; <i>P</i> = .22). Additionally, there were no significant differences between the two groups with respect to postoperative complications or treatment-related toxicities.[<a class="bk_pop" href="#CDR0000062741_rl_44_23">23</a>] Based on these results, preoperative chemotherapy without radiation therapy should still be considered under clinical evaluation.</p><p id="CDR0000062741__50">Two randomized trials have shown no significant OS benefit
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for postoperative radiation therapy over surgery alone.[<a class="bk_pop" href="#CDR0000062741_rl_44_24">24</a>,<a class="bk_pop" href="#CDR0000062741_rl_44_25">25</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>] All newly
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diagnosed patients should be considered candidates for therapies and
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clinical trials comparing various treatment modalities.
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</p><p id="CDR0000062741__201">Information about ongoing clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p><p id="CDR0000062741__51">Special attention to nutritional support is indicated in any patient undergoing
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treatment of esophageal cancer. (Refer to the PDQ summary on <a href="/books/n/pdqcis/CDR0000276584/">Nutrition in Cancer Care</a> for more information.)
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</p></div><div id="CDR0000062741_rl_44"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062741_rl_44_1">Lerut T, Coosemans W, Van Raemdonck D, et al.: Surgical treatment of Barrett's carcinoma. Correlations between morphologic findings and prognosis. J Thorac Cardiovasc Surg 107 (4): 1059-65; discussion 1065-6, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/8159027" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8159027</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_2">Ginsberg RJ: Cancer treatment in the elderly. J Am Coll Surg 187 (4): 427-8, 1998. [<a href="https://pubmed.ncbi.nlm.nih.gov/9783791" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9783791</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_3">Ellis FH Jr, Williamson WA, Heatley GJ: Cancer of the esophagus and cardia: does age influence treatment selection and surgical outcomes? J Am Coll Surg 187 (4): 345-51, 1998. [<a href="https://pubmed.ncbi.nlm.nih.gov/9783779" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9783779</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_4">Hulscher JB, van Sandick JW, de Boer AG, et al.: Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347 (21): 1662-9, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/12444180" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12444180</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_5">de Boer AG, van Lanschot JJ, van Sandick JW, et al.: Quality of life after transhiatal compared with extended transthoracic resection for adenocarcinoma of the esophagus. J Clin Oncol 22 (20): 4202-8, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/15483031" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15483031</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_6">Saxon RR, Morrison KE, Lakin PC, et al.: Malignant esophageal obstruction and esophagorespiratory fistula: palliation with a polyethylene-covered Z-stent. Radiology 202 (2): 349-54, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9015055" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9015055</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_7">Campbell WR Jr, Taylor SA, Pierce GE, et al.: Therapeutic alternatives in patients with esophageal cancer. Am J Surg 150 (6): 665-8, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/4073357" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4073357</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_8">Mellow MH, Pinkas H: Endoscopic therapy for esophageal carcinoma with Nd:YAG laser: prospective evaluation of efficacy, complications, and survival. Gastrointest Endosc 30 (6): 334-9, 1984. [<a href="https://pubmed.ncbi.nlm.nih.gov/6210226" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6210226</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_9">Fleischer D, Sivak MV Jr: Endoscopic Nd:YAG laser therapy as palliation for esophagogastric cancer. Parameters affecting initial outcome. Gastroenterology 89 (4): 827-31, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/2411619" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2411619</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_10">Karlin DA, Fisher RS, Krevsky B: Prolonged survival and effective palliation in patients with squamous cell carcinoma of the esophagus following endoscopic laser therapy. Cancer 59 (11): 1969-72, 1987. [<a href="https://pubmed.ncbi.nlm.nih.gov/2436743" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2436743</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_11">Kelsen DP, Bains M, Burt M: Neoadjuvant chemotherapy and surgery of cancer of the esophagus. Semin Surg Oncol 6 (5): 268-73, 1990. [<a href="https://pubmed.ncbi.nlm.nih.gov/2237085" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2237085</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_12">Cooper JS, Guo MD, Herskovic A, et al.: Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA 281 (17): 1623-7, 1999. [<a href="https://pubmed.ncbi.nlm.nih.gov/10235156" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10235156</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_13">Smith TJ, Ryan LM, Douglass HO Jr, et al.: Combined chemoradiotherapy vs. radiotherapy alone for early stage squamous cell carcinoma of the esophagus: a study of the Eastern Cooperative Oncology Group. Int J Radiat Oncol Biol Phys 42 (2): 269-76, 1998. [<a href="https://pubmed.ncbi.nlm.nih.gov/9788404" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9788404</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_14">Minsky BD, Pajak TF, Ginsberg RJ, et al.: 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 (5): 1167-74, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/11870157" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11870157</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_15">van Hagen P, Hulshof MC, van Lanschot JJ, et al.: Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366 (22): 2074-84, 2012. [<a href="https://pubmed.ncbi.nlm.nih.gov/22646630" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22646630</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_16">Bosset JF, Gignoux M, Triboulet JP, et al.: Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 337 (3): 161-7, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9219702" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9219702</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_17">Walsh TN, Noonan N, Hollywood D, et al.: A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 335 (7): 462-7, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8672151" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8672151</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_18">Urba SG, Orringer MB, Turrisi A, et al.: Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 19 (2): 305-13, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11208820" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11208820</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_19">Tepper J, Krasna MJ, Niedzwiecki D, et al.: Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol 26 (7): 1086-92, 2008. [<a href="/pmc/articles/PMC5126644/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5126644</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18309943" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18309943</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_20">Stahl M, Stuschke M, Lehmann N, et al.: Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 23 (10): 2310-7, 2005. [<a href="https://pubmed.ncbi.nlm.nih.gov/15800321" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15800321</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_21">Kelsen DP, Ginsberg R, Pajak TF, et al.: Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 339 (27): 1979-84, 1998. [<a href="https://pubmed.ncbi.nlm.nih.gov/9869669" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9869669</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_22">Medical Research Council Oesophageal Cancer Working Group: Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet 359 (9319): 1727-33, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/12049861" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12049861</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_23">Ando N, Kato H, Igaki H, et al.: A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol 19 (1): 68-74, 2012. [<a href="https://pubmed.ncbi.nlm.nih.gov/21879261" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21879261</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_24">Ténière P, Hay JM, Fingerhut A, et al.: Postoperative radiation therapy does not increase survival after curative resection for squamous cell carcinoma of the middle and lower esophagus as shown by a multicenter controlled trial. French University Association for Surgical Research. Surg Gynecol Obstet 173 (2): 123-30, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/1925862" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1925862</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_25">Fok M, Sham JS, Choy D, et al.: Postoperative radiotherapy for carcinoma of the esophagus: a prospective, randomized controlled study. Surgery 113 (2): 138-47, 1993. [<a href="https://pubmed.ncbi.nlm.nih.gov/8430362" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8430362</span></a>]</div></li></ol></div></div><div id="CDR0000062741__53"><h2 id="_CDR0000062741__53_">Stage 0 Esophageal Cancer</h2><p id="CDR0000062741__54">Stage 0 squamous esophageal cancer is rarely seen in the United States, but
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surgery has been used for this stage of cancer.[<a class="bk_pop" href="#CDR0000062741_rl_53_1">1</a>,<a class="bk_pop" href="#CDR0000062741_rl_53_2">2</a>]
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</p><div id="CDR0000062741__TrialSearch_53_sid_5"><h3>Current Clinical Trials</h3><p id="CDR0000062741__TrialSearch_53_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with
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<a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43665&tt=1&format=2&cn=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage 0 esophageal cancer</a>. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.</p><p id="CDR0000062741__TrialSearch_53_18">General information about clinical trials is also available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000062741_rl_53"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062741_rl_53_1">Rusch VW, Levine DS, Haggitt R, et al.: The management of high grade dysplasia and early cancer in Barrett's esophagus. A multidisciplinary problem. Cancer 74 (4): 1225-9, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/8055442" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8055442</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_53_2">Heitmiller RF, Redmond M, Hamilton SR: Barrett's esophagus with high-grade dysplasia. An indication for prophylactic esophagectomy. Ann Surg 224 (1): 66-71, 1996. [<a href="/pmc/articles/PMC1235248/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1235248</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/8678620" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8678620</span></a>]</div></li></ol></div></div><div id="CDR0000062741__55"><h2 id="_CDR0000062741__55_">Stage I Esophageal Cancer</h2><p id="CDR0000062741__56"><b>Standard treatment options:
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</b></p><ul id="CDR0000062741__234"><li class="half_rhythm"><div>Chemoradiation with subsequent surgery.</div></li><li class="half_rhythm"><div>Surgery.</div></li></ul><p id="CDR0000062741__58"><b>Treatment options under clinical evaluation:</b>
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</p><ul id="CDR0000062741__88"><li class="half_rhythm"><div>Clinical trials. </div></li></ul><div id="CDR0000062741__TrialSearch_55_sid_6"><h3>Current Clinical Trials</h3><p id="CDR0000062741__TrialSearch_55_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with
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<a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43667&tt=1&format=2&cn=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage I esophageal cancer</a>. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.</p><p id="CDR0000062741__TrialSearch_55_18">General information about clinical trials is also available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div></div><div id="CDR0000062741__60"><h2 id="_CDR0000062741__60_">Stage II Esophageal Cancer</h2><p id="CDR0000062741__61"><b>Standard treatment options:</b>
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</p><ol id="CDR0000062741__139"><li class="half_rhythm"><div>Chemoradiation with subsequent surgery.</div></li><li class="half_rhythm"><div>Chemoradiation alone.</div></li><li class="half_rhythm"><div>Surgery alone.</div></li></ol><div id="CDR0000062741__TrialSearch_60_sid_7"><h3>Current Clinical Trials</h3><p id="CDR0000062741__TrialSearch_60_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with
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<a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43672&tt=1&format=2&cn=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage II esophageal cancer</a>. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.</p><p id="CDR0000062741__TrialSearch_60_18">General information about clinical trials is also available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div></div><div id="CDR0000062741__65"><h2 id="_CDR0000062741__65_">Stage III Esophageal Cancer</h2><p id="CDR0000062741__66"><b>Standard treatment options:</b>
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</p><ol id="CDR0000062741__140"><li class="half_rhythm"><div>Chemoradiation with subsequent surgery.</div></li><li class="half_rhythm"><div>Chemoradiation alone.</div></li></ol><div id="CDR0000062741__TrialSearch_65_sid_8"><h3>Current Clinical Trials</h3><p id="CDR0000062741__TrialSearch_65_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with
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<a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43682&tt=1&format=2&cn=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage III esophageal cancer</a>. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.</p><p id="CDR0000062741__TrialSearch_65_18">General information about clinical trials is also available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div></div><div id="CDR0000062741__70"><h2 id="_CDR0000062741__70_">Stage IV Esophageal Cancer</h2><p id="CDR0000062741__71">At diagnosis, approximately 50% of patients with esophageal cancer will have
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metastatic disease and will be candidates for palliative therapy.[<a class="bk_pop" href="#CDR0000062741_rl_70_1">1</a>]
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</p><p id="CDR0000062741__72"><b>Standard treatment options:</b>
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</p><ol id="CDR0000062741__93"><li class="half_rhythm"><div>Chemoradiation with subsequent surgery (for patients with stage IVA disease).</div></li><li class="half_rhythm"><div>Endoscopic-placed stents to provide palliation of dysphagia.[<a class="bk_pop" href="#CDR0000062741_rl_70_2">2</a>]</div></li><li class="half_rhythm"><div>Radiation therapy with or without intraluminal intubation and dilation.
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</div></li><li class="half_rhythm"><div>Intraluminal brachytherapy to provide palliation of dysphagia.[<a class="bk_pop" href="#CDR0000062741_rl_70_3">3</a>,<a class="bk_pop" href="#CDR0000062741_rl_70_4">4</a>]</div></li><li class="half_rhythm"><div>Nd:YAG endoluminal tumor destruction or electrocoagulation.[<a class="bk_pop" href="#CDR0000062741_rl_70_5">5</a>]</div></li><li class="half_rhythm"><div>Chemotherapy has provided partial responses for patients with metastatic
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distal esophageal adenocarcinomas.[<a class="bk_pop" href="#CDR0000062741_rl_70_6">6</a>-<a class="bk_pop" href="#CDR0000062741_rl_70_8">8</a>]
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</div></li></ol><p id="CDR0000062741__78"><b>Treatment options under clinical evaluation:</b>
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</p><p id="CDR0000062741__79">Many agents are active in esophageal cancer. Objective response rates of 30%
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to 60% and median survivals of less than 1 year are commonly reported with
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platinum-based combination regimens with fluorouracil, taxanes, topoisomerase inhibitors, hydroxyurea, or vinorelbine.[<a class="bk_pop" href="#CDR0000062741_rl_70_1">1</a>,<a class="bk_pop" href="#CDR0000062741_rl_70_8">8</a>,<a class="bk_pop" href="#CDR0000062741_rl_70_9">9</a>]
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</p><ul id="CDR0000062741__118"><li class="half_rhythm"><div>Clinical trials evaluating single-agent or combination chemotherapy.
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</div></li></ul><div id="CDR0000062741__TrialSearch_70_sid_9"><h3>Current Clinical Trials</h3><p id="CDR0000062741__TrialSearch_70_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with
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<a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43692&tt=1&format=2&cn=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">stage IV esophageal cancer</a>. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.</p><p id="CDR0000062741__TrialSearch_70_18">General information about clinical trials is also available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000062741_rl_70"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062741_rl_70_1">Enzinger PC, Ilson DH, Kelsen DP: Chemotherapy in esophageal cancer. Semin Oncol 26 (5 Suppl 15): 12-20, 1999. [<a href="https://pubmed.ncbi.nlm.nih.gov/10566606" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10566606</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_70_2">Baron TH: Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med 344 (22): 1681-7, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11386268" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11386268</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_70_3">Sur RK, Levin CV, Donde B, et al.: Prospective randomized trial of HDR brachytherapy as a sole modality in palliation of advanced esophageal carcinoma--an International Atomic Energy Agency study. Int J Radiat Oncol Biol Phys 53 (1): 127-33, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/12007950" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12007950</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_70_4">Gaspar LE, Nag S, Herskovic A, et al.: American Brachytherapy Society (ABS) consensus guidelines for brachytherapy of esophageal cancer. Clinical Research Committee, American Brachytherapy Society, Philadelphia, PA. Int J Radiat Oncol Biol Phys 38 (1): 127-32, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9212013" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9212013</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_70_5">Bourke MJ, Hope RL, Chu G, et al.: Laser palliation of inoperable malignant dysphagia: initial and at death. Gastrointest Endosc 43 (1): 29-32, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8903814" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8903814</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_70_6">Waters JS, Norman A, Cunningham D, et al.: Long-term survival after epirubicin, cisplatin and fluorouracil for gastric cancer: results of a randomized trial. Br J Cancer 80 (1-2): 269-72, 1999. [<a href="/pmc/articles/PMC2363002/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2363002</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/10390007" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10390007</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_70_7">Ross P, Nicolson M, Cunningham D, et al.: Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) With epirubicin, cisplatin, and PVI 5-FU in advanced esophagogastric cancer. J Clin Oncol 20 (8): 1996-2004, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/11956258" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11956258</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_70_8">Taïeb J, Artru P, Baujat B, et al.: Optimisation of 5-fluorouracil (5-FU)/cisplatin combination chemotherapy with a new schedule of hydroxyurea, leucovorin, 5-FU and cisplatin (HLFP regimen) for metastatic oesophageal cancer. Eur J Cancer 38 (5): 661-6, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/11916548" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11916548</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_70_9">Conroy T, Etienne PL, Adenis A, et al.: Vinorelbine and cisplatin in metastatic squamous cell carcinoma of the oesophagus: response, toxicity, quality of life and survival. Ann Oncol 13 (5): 721-9, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/12075740" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12075740</span></a>]</div></li></ol></div></div><div id="CDR0000062741__81"><h2 id="_CDR0000062741__81_">Recurrent Esophageal Cancer</h2><p id="CDR0000062741__82">All recurrent esophageal cancer patients present difficult problems in
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palliation. All patients, whenever possible, should be considered candidates
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for clinical trials as outlined in treatment overview.
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</p><p id="CDR0000062741__83"><b>Standard treatment options:</b>
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</p><ul id="CDR0000062741__94"><li class="half_rhythm"><div>
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Palliative use of any of the standard therapies, including supportive care.
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</div></li></ul><p id="CDR0000062741__85"><b>Treatment options under clinical evaluation:</b>
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</p><ul id="CDR0000062741__95"><li class="half_rhythm"><div>
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Clinical trials. </div></li></ul><div id="CDR0000062741__TrialSearch_81_sid_10"><h3>Current Clinical Trials</h3><p id="CDR0000062741__TrialSearch_81_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with
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|
<a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43721&tt=1&format=2&cn=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">recurrent esophageal cancer</a>. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.</p><p id="CDR0000062741__TrialSearch_81_18">General information about clinical trials is also available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div></div><div id="CDR0000062741__110"><h2 id="_CDR0000062741__110_">Changes to This Summary (07/08/2015)</h2><p id="CDR0000062741__111">The PDQ cancer information summaries are reviewed regularly and updated as
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new information becomes available. This section describes the latest
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changes made to this summary as of the date above.</p><p id="CDR0000062741__323"><b><a href="#CDR0000062741__44">Treatment Option Overview for Esophageal Cancer</a></b></p><p id="CDR0000062741__324">An editorial change was made to this section.</p><p id="CDR0000062741__disclaimerHP_3">This summary is written and maintained by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>, which is
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editorially independent of NCI. The summary reflects an independent review of
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the literature and does not represent a policy statement of NCI or NIH. More
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information about summary policies and the role of the PDQ Editorial Boards in
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maintaining the PDQ summaries can be found on the <a href="#CDR0000062741__AboutThis_1">About This PDQ Summary</a> and <a href="http://www.cancer.gov/publications/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ® - NCI's Comprehensive Cancer Database</a> pages.
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</p></div><div id="CDR0000062741__AboutThis_1"><h2 id="_CDR0000062741__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062741__AboutThis_2"><h3>Purpose of This Summary</h3><p id="CDR0000062741__AboutThis_3">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of esophageal cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.</p></div><div id="CDR0000062741__AboutThis_4"><h3>Reviewers and Updates</h3><p id="CDR0000062741__AboutThis_5">This summary is reviewed regularly and updated as necessary by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p><p id="CDR0000062741__AboutThis_22"> Board members review recently published articles each month to determine whether an article should:</p><ul id="CDR0000062741__AboutThis_6"><li class="half_rhythm"><div>be discussed at a meeting,</div></li><li class="half_rhythm"><div>be cited with text, or</div></li><li class="half_rhythm"><div>replace or update an existing article that is already cited.</div></li></ul><p id="CDR0000062741__AboutThis_7">Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.</p><p>The lead reviewers for Esophageal Cancer Treatment are:</p><ul><li class="half_rhythm"><div>Jason E. Faris, MD (Massachusetts General Hospital)</div></li><li class="half_rhythm"><div>Jennifer Wo, MD (Massachusetts General Hospital)</div></li></ul><p id="CDR0000062741__AboutThis_9">Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's <a href="http://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.</p></div><div id="CDR0000062741__AboutThis_10"><h3>Levels of Evidence</h3><p id="CDR0000062741__AboutThis_11">Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a <a href="/books/n/pdqcis/CDR0000062796/">formal evidence ranking system</a> in developing its level-of-evidence designations.</p></div><div id="CDR0000062741__AboutThis_12"><h3>Permission to Use This Summary</h3><p id="CDR0000062741__AboutThis_13">PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”</p><p id="CDR0000062741__AboutThis_14">The preferred citation for this PDQ summary is:</p><p id="CDR0000062741__AboutThis_15">National Cancer Institute: PDQ® Esophageal Cancer Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: <a href="http://www.cancer.gov/types/esophageal/hp/esophageal-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www.cancer.gov/types/esophageal/hp/esophageal-treatment-pdq</a>. Accessed <MM/DD/YYYY>.</p><p id="CDR0000062741__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in <a href="http://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>, a collection of over 2,000 scientific images.
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</p></div><div id="CDR0000062741__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062741__AboutThis_18">Based on the strength of the available evidence, treatment options may be described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the <a href="http://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062741__AboutThis_20"><h3>Contact Us</h3><p id="CDR0000062741__AboutThis_21">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="http://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="http://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>.</p></div></div><div id="CDR0000062741__GetMore_3"><h2 id="_CDR0000062741__GetMore_3_">Get More Information From NCI</h2><p id="CDR0000062741__GetMore_15"><i><b>Call 1-800-4-CANCER</b></i></p><p id="CDR0000062741__GetMore_16">For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.</p><p id="CDR0000062741__GetMore_25"><i><b>Chat online
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</b></i></p><p id="CDR0000062741__GetMore_26">The <a href="https://livehelp.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's LiveHelp®</a> online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI websites and answer questions about cancer.
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</p><p id="CDR0000062741__GetMore_27"><i><b>Write to us</b></i></p><p id="CDR0000062741__GetMore_28">For more information from the NCI, please write to this address:</p><ul id="CDR0000062741__GetMore_29" class="simple-list"><li class="half_rhythm"><div>NCI Public Inquiries Office</div></li><li class="half_rhythm"><div>9609 Medical Center Dr. </div></li><li class="half_rhythm"><div>Room 2E532 MSC 9760</div></li><li class="half_rhythm"><div>Bethesda, MD 20892-9760</div></li></ul><p id="CDR0000062741__GetMore_17"><i><b>Search the NCI websites</b></i></p><p id="CDR0000062741__GetMore_18">The <a href="http://www.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a> provides online access to information on cancer, clinical trials, and other websites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen web pages that are most closely related to the search term entered.</p><p id="CDR0000062741__GetMore_30">There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.</p><p id="CDR0000062741__GetMore_19"><i><b>Find Publications</b></i></p><p id="CDR0000062741__GetMore_20">The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the <a href="https://pubs.cancer.gov/ncipl" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI Publications Locator</a>. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).</p></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65900.1/?report=reader">PubReader</a></li><li><a href="/books/NBK65900.1/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65900" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65900" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Adult Treatment Editorial Board. Esophageal Cancer Treatment (PDQ®): Health Professional Version. 2015 Jul 8. 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2018</li><li><span class="bk_col_itm"><a href="/books/NBK65900.5/">NBK65900.5</a></span> February 2, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65900.4/">NBK65900.4</a></span> February 4, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65900.3/">NBK65900.3</a></span> December 3, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65900.2/">NBK65900.2</a></span> October 2, 2015</li><li><span class="bk_col_itm">NBK65900.1</span> July 8, 2015 (Displayed Version)</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000062741__1" ref="log$=inpage&link_id=inpage">General Information About Esophageal Cancer</a></li><li><a href="#CDR0000062741__9" ref="log$=inpage&link_id=inpage">Cellular Classification of Esophageal Cancer</a></li><li><a href="#CDR0000062741__12" ref="log$=inpage&link_id=inpage">Stage Information for Esophageal Cancer</a></li><li><a href="#CDR0000062741__44" ref="log$=inpage&link_id=inpage">Treatment Option Overview for Esophageal Cancer</a></li><li><a href="#CDR0000062741__53" ref="log$=inpage&link_id=inpage">Stage 0 Esophageal Cancer</a></li><li><a href="#CDR0000062741__55" ref="log$=inpage&link_id=inpage">Stage I Esophageal Cancer</a></li><li><a href="#CDR0000062741__60" ref="log$=inpage&link_id=inpage">Stage II Esophageal Cancer</a></li><li><a href="#CDR0000062741__65" ref="log$=inpage&link_id=inpage">Stage III Esophageal Cancer</a></li><li><a href="#CDR0000062741__70" ref="log$=inpage&link_id=inpage">Stage IV Esophageal Cancer</a></li><li><a href="#CDR0000062741__81" ref="log$=inpage&link_id=inpage">Recurrent Esophageal Cancer</a></li><li><a href="#CDR0000062741__110" ref="log$=inpage&link_id=inpage">Changes to This Summary (07/08/2015)</a></li><li><a href="#CDR0000062741__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li><li><a href="#CDR0000062741__GetMore_3" ref="log$=inpage&link_id=inpage">Get More Information From NCI</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK66028/">Patient Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div 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