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The Role of Chemoradiation in the Management of Esophageal Cancer

  • Chapter
Chemoradiation in Cancer Therapy

Part of the book series: Cancer Drug Discovery and Development ((CDD&D))

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Abstract

It is estimated that there will be 13,200 new cases of esophageal cancer in the year 2001 and an estimated 500 deaths (1). Over the past two decades, tumor registry data obtained from the Surveillance, Epidemiology, and End Results (SEER) program has shown a decrease in the age-adjusted incidence of squamous cell carcinoma, while there has been a steady increase in the incidence of adenocarcinoma. Since the mid-1970s the incidence of adenocarcinoma has risen >350%, surpassing that of squamous cell cancers around 1990. Although the rate among black males has increased, it remains at much lower levels (2). While certain risk factors for the development of squamous cell carcinomas have been identified (smoking, alcohol, diet), these are less clear for adenocarcinoma of the esophagus. Smoking remains a risk factor, but there appears to be less of an association with alcohol (3). Barrett’s esophagus has been shown to be a predisposing factor for adenocarcinoma of the esophagus. In a population-based study from Sweden, the frequency, severity, and duration of reflux symptoms were found to be strongly correlated with the risk of developing adenocarcinoma (odds ratio, 43.5) but not squamous cell carcinoma (odds ratio, 1.1) of the esophagus (4). There is increasing clinical, as well as molecular, evidence suggesting that dysplasia in Barrett’ s esophagus is a precursor to esophageal adenocarcinoma. DNA replication errors and allelic losses of chromosomes 17p, 18q, and 5q were studied in 36 patients who underwent resection for adenocarcinoma of the esophagus. There was an accumulation of genetic alterations from dysplasia to adenocarcinoma. Allelic loss of both 17p and 18q was associated with the worst prognosis (5). Obesity, which may predispose patients to reflux, is also emerging as a potential risk factor.

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  1. Arlene Forastiere MD
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  2. Bapsi Chak MD
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Editors and Affiliations

  1. Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA

    Hak Choy MD

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Forastiere, A., Chak, B. (2003). The Role of Chemoradiation in the Management of Esophageal Cancer. In: Choy, H. (eds) Chemoradiation in Cancer Therapy. Cancer Drug Discovery and Development. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-325-5_11

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