Treatment of Recurrent Esophageal Cancer
Patients with recurrent esophageal cancer have cancer that has recurred after primary treatment.
The following is a general overview of the treatment of recurrent esophageal cancer. Circumstances unique to your situation and prognostic factors (factors that help your physician estimate your chance of recovery or the chance that your cancer will come back) may ultimately influence how your physician applies these general treatment principles to your situation. The information on this website is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.
Most new treatments come about through clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Developing more effective cancer treatments requires cancer patients to help evaluate these new and innovative therapies.
Participating in a clinical trial may offer you access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. If you’re interested in participating in a clinical trial, you should discuss the risks and benefits of clinical trials with your physician. To ensure that you’re receiving the optimal treatment for your cancer, it’s important to stay informed and follow the cancer news to learn about new treatments and clinical trial results.
There are currently no standard curative therapies for treatment of recurrent esophageal cancer. The predominant symptom of esophageal cancer is dysphagia, which simply refers to difficulty in swallowing food and liquids. There are specific treatments that can be administered that can result in short-term benefit and improvement in nutrition. Current treatment approaches are primarily directed at controlling the symptoms of cancer and prolonging a patient’s survival. A number of treatment options are currently used alone or in combination to achieve optimal results.
Palliative surgery - Patients who have recurrent cancer after chemotherapy and/or radiation therapy can be treated with esophagectomy. However, there are usually more surgical complications in patients who have received prior radiation therapy than in patients who undergo surgery as primary treatment.
Radiation therapy - Patients who fail surgery alone can often be treated successfully with radiation therapy with or without chemotherapy. Radiation therapy can be extremely effective in temporarily controlling local symptoms from esophageal cancer.
Chemotherapy - Single chemotherapy drugs such as Platinol® (cisplatin), fluorouracil, Mutamycin® (mitomycin), Doxil® (doxorubicin), and Ellence® (epirubicin) may result in clinical remissions (inactive state of disease) in patients with esophageal cancer. Standard combination chemotherapy treatment regimens have often used cisplatin with fluorouracil and epirubicin or mitomycin. The overall response rate for these combination regimens is approximately 40 percent, and the average survival duration is 8 to 10 months.
Recent studies indicate that taxanes (Taxol® [paclitaxel] and Taxotere® [docetaxel]) may be the most active single chemotherapy drugs for the treatment of esophageal cancer, with complete remissions occurring in up to 15 percent of patients. Other agents that have been or are being evaluated include Camptosar® (irinotecan) and Gemzar® (gemcitabine).
Other Treatment Modalities
Physicians use many other treatment modalities to prolong survival and quality of life for patients with esophageal cancer.
Thermal laser treatment - Thermal laser destruction of cancer cells using endoscopy (a procedure allowing the physician to view the inside of the esophagus and to insert instruments to remove a tissue sample) may provide temporary relief of dysphagia, or difficulty swallowing.
Laser ablation (removing cancer cells with a laser) appears to be most helpful for treating polypoid cancers (polyps or growths that are malignant) that grow into the esophagus causing blockage. Laser treatment is less effective for upper esophageal cancers or cancers of the gastroesophageal junction (the lower part of the esophagus that connects to the stomach).
Photodynamic treatment - Photodynamic treatment is a type of laser treatment that involves injecting photosensitizing chemicals into the bloodstream. Cells throughout the body absorb the chemicals. The chemicals collect and stay longer in the cancer cells than in the healthy cells. At the right time, when the healthy cells surrounding the tumor may already be relatively free of the chemical, the light of a laser focuses directly on the tumor. As the cells absorb the light, a chemical reaction destroys the cancer cells. The light comes through a small, flexible tube called an endoscope, which enters through the mouth or nose.
Photodynamic therapy may relieve or reduce some of the symptoms of esophageal cancer, such as difficulty swallowing.
Esophageal dilation - Often, after administering chemotherapy, radiation therapy, laser, or photodynamic treatment, the area of the esophagus with cancer may narrow. Narrowing of the esophagus may be due to recurrent cancer or to treatment-related narrowing, or both. Relief of this constriction by dilation can temporarily improve swallowing.
During esophageal dilation, a physician uses endoscopic or fluoroscopic (instruments to help view the area) guidance to pass flexible dilators (mercury-filled rubber tubes) through the patient’s mouth. The physician then introduces increasing diameters of dilators, called bougies, until the swallowing difficulty resolves.
Esophageal stents or prostheses - Stents are rigid tubes that stay in the esophagus to keep it open.
Research is in progress to refine existing treatments and develop new ones. For information on some of the techniques currently under investigation, see Strategies to Improve Treatment.
This content was last modified on
November 16, 2007
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