Skip to main content

Advertisement

SpringerLink
Log in

Multimodality Management of Esophageal Cancer

  • Original Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

Esophageal cancer is a morbid disease with a grim prognosis. The outcomes of treatment even in non-metastatic disease undergoing potentially curative surgery are poor with 5-year survival ranging from 20 to 35 %. Several multimodality treatment options have been investigated in well-conducted randomised trials and meta-analyses evaluating both neoadjuvant and adjuvant therapies. However, there is still lack of uniform practice in the management of operable esophageal cancer. We review the current evidence for multimodality treatment of esophageal cancer, critically analysing the evidence supporting the use of each strategy, the pros and cons of each approach and discuss our approach in management. Neoadjuvant chemotherapy or chemoradiotherapy are currently the standard of care in localised esophageal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ferlay J, Soerjomataram I, Ervik M et al. (2012). GLOBOCAN, cancer incidence and mortality worldwide: IARC cancer base no. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://globocan.iarc.fr (Accessed on 22nd Dec 2013)

  2. National Cancer Registry 2004. Available from http://www.icmr.nic.in/ncrp/first_report_2003-04/Chapter%20Final%20Pages%201%20to%2071.pdf (Accessed on 22nd Dec 2013)

  3. Jha P, Gajalakshmi V, Gupta PC et al (2006) Prospective study of one million deaths in India: rationale, design, and validation results. PLoS Med 3:191–200

    Article  Google Scholar 

  4. Kelsen DP, Winter KA, Gunderson LL et al (2009) Long-term results of RTOG trial 8911 (USA Intergroup113): a random assignment trial comparison of chemotherapy followed by surgery compared with surgery alone for esophageal cancer. J Clin Oncol 27:5062–5067

    Article  Google Scholar 

  5. Allum WH, Stenning SP, Bancewicz J et al (2009) Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer. J ClinOncol 27:5062–5067

    Article  Google Scholar 

  6. van Hagen P, Hulshof MC, van Lanschot JJ (2012) Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366:2074–2084

    Article  PubMed  Google Scholar 

  7. Boone J, Livestro DP, Elias SG et al (2009) International survey on esophageal cancer: part II staging and neoadjuvant therapy. Dis Esophagus 22:203–210

    Article  CAS  PubMed  Google Scholar 

  8. Geh JI, Crellin AM, Glynne-Jones R (2001) Preoperative (neoadjuvant) chemoradiotherapy in oesophageal cancer. Br J Surg 88:338–356

    Article  CAS  PubMed  Google Scholar 

  9. Hingorani M, Crosby T, Maraveyas A et al (2011) Neoadjuvant chemoradiotherapy for resectable oesophageal and gastro-oesophageal junction cancer—do we need another randomized trial? Clin Oncol 23:696–705

    Article  CAS  Google Scholar 

  10. Arnott SJ, Duncan W, Gignoux M et al (1998) Preoperative radiotherapy in esophageal carcinoma: a meta-analysis using individual patient data (Oesophageal Cancer Collaborative group). Int J Radiat Oncol Biol Phys 41:579–583

    Article  CAS  PubMed  Google Scholar 

  11. Roth JA, Pass HI, Flanagan MM et al (1988) Randomized clinical trial of preoperative and postoperative adjuvant chemotherapy with cisplatin, vindesine, and bleomycin for carcinoma of the esophagus. J Thorac Cardiovasc Surg 96:242–248

    CAS  PubMed  Google Scholar 

  12. Nygaard K, Hagen S, Hansen HS et al (1992) Pre-operative radiotherapy prolongs survival in operable esophageal carcinoma: a randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second Scandinavian trial in esophageal cancer. World J Surg 16:1104–1109

    Article  CAS  PubMed  Google Scholar 

  13. Schlag PM (1992) Randomized trial of preoperative chemotherapy for squamous cell cancer of the esophagus. The Chirurgische Arbeitsgemeinschaft Fuer Onkologie der Deutschen Gesellschaft Fuer Chirurgie Study Group. Arch Surg 127:1446–1450

    Article  CAS  PubMed  Google Scholar 

  14. Maipang T, Vasinanukorn P, Petpichetchian C et al (1994) Induction chemotherapy in the treatment of patients with carcinoma of the esophagus. J Surg Oncol 56:191–197

    Article  CAS  PubMed  Google Scholar 

  15. Law S, Fok M, Chow S et al (1997) Preoperative chemotherapy versus surgical therapy alone for squamous cell carcinoma of the esophagus: a prospective randomized trial. J Thorac Cardiovasc Surg 114:210–217

    Article  CAS  PubMed  Google Scholar 

  16. Boonstra JJ, Kok TC, Wijnhoven BP et al (2011) Chemotherapy followed by surgery versus surgery alone in patients with oesophageal squamous cell carcinoma: long-term results of a randomized controlled trial. BMC Cancer 11:181

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Ancona E, Ruol A, Santi S et al (2001) Only pathologic complete response to neoadjuvant chemotherapy improves significantly the long term survival of patients with resectable esophageal squamous cell carcinoma: final report of a randomized, controlled trial of preoperative chemotherapy versus surgery alone. Cancer 91:2165–2174

    Article  CAS  PubMed  Google Scholar 

  18. Ychou M, Boige V, Pignon J-P et al (2011) Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 29:1715–1721

    Article  CAS  PubMed  Google Scholar 

  19. Kelsen DP, Ginsberg R, Pajak T et al (1998) Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 339:1979–1984

    Article  CAS  PubMed  Google Scholar 

  20. Medical Research Council Oesophageal Cancer Working Party (2002) Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet 359:1727–1733

    Article  Google Scholar 

  21. Cunningham D, Allum WH, Stenning SP et al. (2006). Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med; 355:11-20.

  22. Urschel JD, Vasan H, Blewett CJ (2002) A meta-analysis of randomized controlled trials that compared neoadjuvant chemotherapy and surgery to surgery alone for resectable esophageal cancer. Am J Surg 183:274–279

    Article  PubMed  Google Scholar 

  23. Kaklamanos IG, Walker GR, Ferry K et al (2003) Neoadjuvant treatment for resectable cancer of the esophagus and the gastroesophageal junction: a meta-analysis of randomized clinical trials. Ann Surg Oncol 10:754–761

    Article  PubMed  Google Scholar 

  24. Malthaner RA, Wong RKS, Rumble RB et al (2004) Neoadjuvant or adjuvant therapy for resectable esophageal cancer: a systematic review and meta-analysis. BMC Medicine 2:35

    Article  PubMed Central  PubMed  Google Scholar 

  25. Gebski V, Burmeister B, Smithers BM et al (2007) Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 8:226–234

    Article  CAS  PubMed  Google Scholar 

  26. Sjoquist KM, Burmeister BH, Smithers BM et al (2011) Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol 12:681–692

    Article  PubMed  Google Scholar 

  27. Apinop C, Puttisak P, Preecha N (1994) A prospective study of combined therapy in esophageal cancer. Hepatogastroenterology; 41:391–393

    CAS  PubMed  Google Scholar 

  28. Le PE, Etienne PL, Meunier B et al (1994) A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus. Cancer 73:1779–1784

    Article  Google Scholar 

  29. Walsh T.(1995). The role of multimodality therapy in improving survival: a prospective randomised trial. In: Predicting, defining and improving outcomes for oesophageal carcinoma [MD thesis]. Dublin: Trinity College, University of Dublin: 124–50

  30. Walsh TN, Noonan N, Hollywood D et al (1996) A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 335:462–467

    Article  CAS  PubMed  Google Scholar 

  31. Urba SG, Orringer MB, Turrisi A et al (2001) Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 19:305–313

    CAS  PubMed  Google Scholar 

  32. Lee JL, Park SI, Kim SB et al (2004) A single institutional phase III trial of preoperative chemotherapy with hyperfractionation radiotherapy plus surgery versus surgery alone for resectable esophageal squamous cell carcinoma. Ann Oncol 15:947–954

    Article  CAS  PubMed  Google Scholar 

  33. Burmeister BH, Smithers BM, Gebski V et al (2005) Australasian Gastro-Intestinal Trials Group. Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomized controlled phase III trial. Lancet Oncol 6:659–668

    Article  PubMed  Google Scholar 

  34. Tepper J, Krasna MJ, Niedzwiecki D et al (2008) Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol 26:1086–1092

    Article  CAS  PubMed  Google Scholar 

  35. Mariette C, Seitz JF, Maillard E, et al. (2010). Surgery alone versus chemoradiotherapy followed by surgery for localized esophageal cancer: analysis of a randomized controlled phase III trial FFCD 9901. Proc Am Soc Clin Oncol 2010; 28 (15 suppl)

  36. Lv J, Cao XF, Zhu B et al (2010) Long-term efficacy of perioperative chemoradiotherapy on esophageal squamous cell carcinoma. World J Gastroenterol 16:1649–1654

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. van der Gaast A, van Hagen P, Hulshof M et al (2010) Effect of preoperative concurrent chemoradiotherapy on survival of patients with resectable esophageal or esophagogastric junction cancer: results from a multicenter randomized phase III study. Proc Am Soc Clin Oncol 28(15 suppl)

  38. Bosset JF, Gignoux M, Triboulet JP et al (1997) Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 337:161–167

    Article  CAS  PubMed  Google Scholar 

  39. Oppedijk V, van der Gaast A, van Lanschot JJ. (2014). Patterns of recurrence after surgery alone versus preoperative chemoradiotherapy and surgery in the CROSS trials. J Clin Oncol. [Epub ahead of print]

  40. Urschel JD, Vasan H. (2003). A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer. Am J Surg; 185:538-43.

  41. Fink U, Stein HJ, Wilke H (1995) Multimodal treatment for squamous cell esophageal cancer. World J Surg 19:198–204

    Article  CAS  PubMed  Google Scholar 

  42. Stahl M, Walz MK, Stuschke M et al (2009) Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol 27:851–856

    Article  CAS  PubMed  Google Scholar 

  43. Fok M, Sham JST, Choy D et al (1993) Postoperative radiotherapy for carcinoma of the esophagus: a prospective, randomized controlled study. Surgery 113:138–147

    CAS  PubMed  Google Scholar 

  44. Teniere P, Hay JM, Fingerhut A et al (1991) 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 173:123–130

    CAS  PubMed  Google Scholar 

  45. Zieren HU, Muller JM, Jacobi CA et al (1995) Adjuvant postoperative radiation therapy after curative resection of squamous cell carcinoma of the thoracic esophagus: a prospective randomized study. World J Surg 19:444–449

    Article  CAS  PubMed  Google Scholar 

  46. Xiao ZF, Yang ZY, Liang J et al (2003) Value of radiotherapy after radical surgery for esophageal carcinoma: a report of 495 patients. Ann Thorac Surg 75:331–336

    Article  PubMed  Google Scholar 

  47. Cunningham D, Allum WH, Stenning SP et al (2006) Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355:11–20

    Article  CAS  PubMed  Google Scholar 

  48. Ando N, Iizuka T, Ide H (2003) Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus: a Japan Clinical Oncology Group study—JCOG9204. J Clin Oncol 21:4592–4596

    Article  PubMed  Google Scholar 

  49. Pouliquen X, Levard H, Hay JM et al (1996) 5-fluorouracil and cisplatin therapy after palliative surgical resection of squamous cell carcinoma of the esophagus. A multicenter randomized trial. French Associations for Surgical Research. Ann Surg 223:127–133

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  50. Ando N, Iizuka T, Kakegawa T (1997) A randomized trial of surgery with and without chemotherapy for localized squamous carcinoma of the thoracic esophagus: the Japan Clinical Oncology Group Study. J Thorac Cardiovasc Surg 114:205–209

    Article  CAS  PubMed  Google Scholar 

  51. Zhang J, Chen HQ, Zhang YW et al (2008) Adjuvant chemotherapy in oesophageal cancer: a meta-analysis and experience from the Shanghai Cancer Hospital. J Int Med Res 36:875–882

    Article  CAS  PubMed  Google Scholar 

  52. Ando N, Kato H, Igaki H (2012) 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 19:68–74

    Article  PubMed  Google Scholar 

  53. Bhansali MS, Vaidya JS, Bhatt RG et al (1996) Chemotherapy for carcinoma of the esophagus: a comparison of evidence from meta-analyses of randomized trials and of historical control studies. Ann Oncol 7:335–355

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Thoracic Oncology Disease Management Group, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, 400012, India

    Pallavi Purwar, Supriya Bambarkar, Sabita Jiwnani, George Karimundackal & C. S. Pramesh

  2. Thoracic Oncology Disease Management Group, Department of Radiation Oncology, Tata Memorial Centre, Mumbai, 400012, India

    Sarbani Ghosh Laskar

Authors
  1. Pallavi Purwar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Supriya Bambarkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sabita Jiwnani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. George Karimundackal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sarbani Ghosh Laskar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. S. Pramesh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. S. Pramesh.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Purwar, P., Bambarkar, S., Jiwnani, S. et al. Multimodality Management of Esophageal Cancer. Indian J Surg 76, 494–503 (2014). https://doi.org/10.1007/s12262-014-1163-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-014-1163-x

Keywords

Search

Navigation