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Information from PDQ -- for Health Professionals
Esophageal cancer
208/00089
** GENERAL INFORMATION **
Note: Separate PDQ summaries on Prevention of Esophageal Cancer and Screening
for Esophageal Cancer are also available.
The incidence of esophageal cancer has risen in recent decades, coinciding with
a shift in histologic type and primary tumor location.[1,2] Adenocarcinoma of
the esophagus is now more prevalent than squamous cell carcinoma in the United
States and western Europe, with most tumors located in the distal esophagus.
The cause for the rising incidence and demographic alterations is unknown.
Gastrointestinal stromal tumors can occur in the esophagus and are usually
benign. (Refer to the PDQ summary on Adult Soft Tissue Sarcoma Treatment for
more information.)
While risk factors for squamous cell carcinoma of the esophagus have been
identified (tobacco, alcohol, diet, etc.), the risk factors associated with
esophageal adenocarcinoma are less clear.[2] The presence of Barrett's
esophagus is associated with an increased risk of developing adenocarcinoma of
the esophagus, and chronic reflux is considered the predominate cause of
Barrett's metaplasia. The results of a population-based, case-controlled study
from Sweden strongly suggest that symptomatic gastroesophageal reflux is a risk
factor for esophageal adenocarcinoma. The frequency, severity, and duration of
reflux symptoms were positively correlated with increased risk of esophageal
adenocarcinoma.[3]
Esophageal cancer is a treatable disease that is rarely curable. The overall
5-year survival rate in patients amenable to surgery ranges from 5% to 20%.
The occasional patient with very early disease has a better chance of survival.
Patients with severe dysplasia in distal esophageal Barrett's mucosa often have
in situ or even invasive cancer within the dysplastic area. Following
resection, these patients usually have an excellent prognosis.
Primary treatment modalities include surgery alone or chemotherapy with
radiation therapy. Combined modality therapy (chemotherapy plus surgery, or
chemotherapy and radiation therapy plus surgery) is under clinical evaluation.
Effective palliation may be obtained in individual cases with various
combinations of surgery, chemotherapy, radiation therapy, stents,[4]
photodynamic therapy,[5-7] and endoscopic therapy with Nd:YAG laser.[8]
One of the major difficulties in allocating and comparing treatment modalities
for patients with esophageal cancer is the lack of precise pre-operative
staging. Standard noninvasive staging modalities include computed tomography
(CT) of the chest and abdomen, and endoscopic ultrasound (EUS). The overall
tumor depth staging accuracy of EUS is 85% to 90%, as compared to 50% to 80%
for CT; the accuracy of regional nodal staging is 70% to 80% for EUS and 50% to
70% for CT.[9,10] EUS-guided fine-needle aspiration (FNA) for lymph node
staging is under prospective evaluation; one retrospective series reported a
93% accuracy of regional nodal staging with EUS-FNA.[11] Thoracoscopy and
laparoscopy have been used in esophageal cancer staging at some surgical
centers.[12-14] Noninvasive positron emission tomography using the
radiolabeled glucose analog 18-F-fluoro-deoxy-D-glucose for pre-operative
staging of esophageal cancer is under clinical evaluation and may be useful in
detecting stage IV disease.[15]
References:
1. Devesa SS, Blot WJ, Fraumeni JK Jr: Changing patterns in the incidence of
esophageal and gastric carcinoma in the United States. Cancer 83(10):
2049-2053, 1998.
2. Blot WJ, McLaughlin JK: The changing epidemiology of esophageal cancer.
Seminars in Oncology 26(5 suppl 15): 2-8, 1999.
3. Lagergren J, Bergstrom R, Lindgren A, et al.: Symptomatic
gastroesophageal reflux as a risk factor for esophageal adenocarcinoma.
New England Journal of Medicine 340(11): 825-831, 1999.
4. Tietjen TG, Pasricha PJ, Kalloo AN: Management of malignant esophageal
stricture with esophageal dilation and esophageal stents.
Gastrointestinal Endoscopy Clinics of North America 4(4): 851-862, 1994.
5. Lightdale CJ, Heier SK, Marcon NE, et al.: Photodynamic therapy with
porfimer sodium versus thermal ablation therapy with Nd:YAG laser for
palliation of esophageal cancer: a multicenter randomized trial.
Gastrointestinal Endoscopy 42(6): 507-512, 1995.
6. Kubba AK: Role of photodynamic therapy in the management of
gastrointestinal cancer. Digestion 60(1): 1-10, 1999.
7. Heier SK, Heier LM: Tissue sensitizers. Gastrointestinal Endoscopy
Clinics of North America 4(2): 327-252, 1994.
8. Bourke MJ, Hope RL, Chu G, et al.: Laser palliation of inoperable
malignant dysphagia: initial and at death. Gastrointestinal Endoscopy
43(1): 29-32, 1996.
9. Ziegler K, Sanft C, Zeitz M, et al.: Evaluation of endosonography in TN
staging of oesophageal cancer. Gut 32(1): 16-20, 1991.
10. Tio TL, Coene PP, den Hartog Jager FC, et al.: Preoperative TNM
classification of esophageal carcinoma by endosonography.
Hepato-gastroenterology 37(4): 376-381, 1990.
11. Vazquez-Sequeiros E, Norton ID, Clain JE, et al.: Impact of EUS-guided
fine-needle aspiration on lymph node staging in patients with esphogeal
cancer. Gastrointestinal Endoscopy 53(7): 751-757, 2001.
12. Bonavina L, Incarbone R, Lattuada E, et al.: Preoperative laparoscopy in
management of patients with carcinoma of the esophagus and of the
esophagogastric junction. Journal of Surgical Oncology 65(3): 171-174,
1997.
13. Sugarbaker DJ, Jaklitsch MT, Liptay MJ: Thoracoscopic staging and
surgical therapy for esophageal cancer. Chest 107(suppl 6): 218S-223S,
1995.
14. 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. Journal of Thoracic and Cardiovascular
Surgery 114(5): 817-823, 1997.
15. Flamen P, Lerut A, Van Cutsem E, et al.: Utility of positron emission
tomography for the staging of patients with potentially operable
esophageal carcinoma. Journal of Clinical Oncology 18(18): 3202-3210,
2000.
** CELLULAR CLASSIFICATION **
Fewer than 50% of esophageal cancers are squamous cell carcinomas.
Adenocarcinomas, typically arising in Barrett's esophagus, account for at least
50% of malignant lesions, and the incidence of this histology appears to be
rising. Barrett's esophagus contains glandular epithelium cephalad to the
esophagogastric junction. Three different types of glandular epithelium can be
seen: metaplastic columnar epithelium, metaplastic parietal cell glandular
epithelium within the esophageal wall, or metaplastic intestinal epithelium
with typical goblet cells. Dysplasia is particularly likely to develop in the
intestinal type mucosa.
Gastrointestinal stromal tumors can occur in the esophagus and are usually
benign. (Refer to the PDQ summary on Adult Soft Tissue Sarcoma Treatment for
more information.)
** STAGE INFORMATION **
The stage determines whether the intent of the therapeutic approach will be
curative or palliative. The American Joint Committee on Cancer (AJCC) has
designated staging by TNM classification.[1]
-- TNM definitions --
Primary tumor (T)
TX: Primary tumor cannot be assessed
T0: No evidence of primary tumor
Tis: Carcinoma in situ
T1: Tumor invades lamina propria or submucosa
T2: Tumor invades muscularis propria
T3: Tumor invades adventitia
T4: Tumor invades adjacent structures
Regional lymph nodes (N)
NX: Regional lymph nodes cannot be assessed
N0: No regional lymph node metastasis
N1: Regional lymph node metastasis
Distant metastasis (M)
MX: Distant metastasis cannot be assessed
M0: No distant metastasis
M1: Distant metastasis
Tumors of the lower thoracic esophagus:
M1a: Metastasis in celiac lymph nodes
M1b: Other distant metastasis
Tumors of the midthoracic esophagus:
M1a: Not applicable
M1b: Nonregional lymph nodes and/or other distant metastasis
Tumors of the upper thoracic esophagus:
M1a: Metastasis in cervical nodes
M1b: Other distant metastasis
For tumors of midthoracic esophagus use only M1b, since these tumors with
metastasis in nonregional lymph nodes have an equally poor prognosis as those
with metastasis in other distant sites.
-- AJCC stage groupings --
-- Stage 0 --
Tis, N0, M0
-- Stage I --
T1, N0, M0
-- Stage IIA --
T2, N0, M0
T3, N0, M0
-- Stage IIB --
T1, N1, M0
T2, N1, M0
-- Stage III --
T3, N1, M0
T4, Any N, M0
-- Stage IV --
Any T, Any N, M1
-- Stage IVA --
Any T, Any N, M1a
-- Stage IVB --
Any T, Any N, M1b
The current staging system for esophageal cancer is based largely on
retrospective data from the Japanese Committee for Registration of Esophageal
Carcinoma. It is most applicable to patients with squamous cell carcinomas of
the upper- and middle-thirds of the esophagus, as opposed to the increasingly
common distal esophageal and gastroesophageal junction adenocarcinomas.[2] In
particular, the classification of involved abdominal lymph nodes as M1 disease
has been criticized. The presence of positive abdominal lymph nodes does not
appear to carry as grave a prognosis as metastases to distant organs.[3]
Patients with regional and/or celiac axis lymphadenopathy should not
necessarily be considered to have unresectable disease due to metastases.
Complete resection of the primary tumor and appropriate lymphadenectomy should
be attempted when possible.
References:
1. Esophagus. In: American Joint Committee on Cancer: AJCC Cancer Staging
Manual. Philadelphia, Pa: Lippincott-Raven Publishers, 5th ed., 1997, pp
65-69.
2. Parameters linked to ten-year survival in Japan of resected esophageal
carcinoma. Japanese Committee for Registration of Esophageal Carcinoma
Cases. Chest 96(5): 1005-1011, 1989.
3. Korst RJ, Rusch VW, Venkatraman E, et al.: Proposed revision of the
staging classification for esophageal cancer. Journal of Thoracic and
Cardiovascular Surgery 115(3): 660-670, 1998.
** TREATMENT OPTION OVERVIEW **
The prevalence of Barrett's metaplasia in adenocarcinoma of the esophagus
suggests that Barrett's esophagus may be a premalignant condition. Strong
consideration should be given to resection in patients with high-grade
dysplasia in the setting of Barrett's metaplasia. Endoscopic surveillance of
patients with Barrett's metaplasia may detect adenocarcinoma at an earlier
stage more amenable to curative resection.[1] The survival rate of patients
with esophageal cancer is poor. Asymptomatic small tumors confined to the
esophageal mucosa or submucosa are detected only by chance. Surgery is the
treatment of choice for these small tumors. Once symptoms are present
(dysphagia, in the majority of cases), esophageal cancers have usually invaded
the muscularis propria or beyond and may have metastasized to lymph nodes or
other organs.
In the presence of complete esophageal obstruction, without clinical evidence
of systemic metastasis, surgical excision of the tumor with mobilization of the
stomach to replace the esophagus has been the traditional means of relieving
the dysphagia. In the United States, the median age of patients who present
with esophageal cancer is 67 years of age.[2] The results of a retrospective
review of 505 consecutive patients who were operated on by a single surgical
team over 17 years found no difference in the perioperative mortality, median
survival, or palliative benefit of esophagectomy on dysphagia when the group of
patients older than 70 were compared to their younger peers.[3][Levels of
evidence: 3iiA, 3iiB] All of the patients in this series were selected for
surgery based on potential operative risk. Age alone should not determine
therapy for patients with potentially resectable disease.
There is controversy as to the optimal surgical procedure. One approach
advocates transhiatal esophagectomy with anastomosis of the stomach to the
cervical esophagus. A second approach advocates abdominal mobilization of the
stomach and transthoracic excision of the esophagus with anastomosis of the
stomach to the upper thoracic esophagus or the cervical esophagus. In patients
with partial esophageal obstruction, dysphagia may, at times, be relieved by
placement of an expandable metallic stent [4] or by radiation therapy if the
patient has disseminated disease or is not a candidate for surgery.
Alternative methods of relieving dysphagia have been reported, including laser
therapy and electrocoagulation to destroy intraluminal tumor.[5-8]
Surgical treatment of resectable esophageal cancers results in 5-year survival
rates of 5% to 20%, with higher survival rates in patients with early stage
cancers. This is associated with a less than 10% operative mortality rate.[9]
In an attempt to avoid this perioperative mortality and to relieve dysphagia,
definitive radiation therapy in combination with chemotherapy has been studied.
One series from Fox Chase, evaluating radiation therapy and chemotherapy with
fluorouracil and mitomycin, produced a 75% local control rate, associated with
improved swallowing, and a 30% actuarial disease-free survival (18% overall
survival) at 5 years for stage I and stage II patients.[10] An intergroup
randomized trial of chemotherapy and radiation therapy versus radiation therapy
alone resulted in an improvement in 5-year survival for the combined modality
group (26% versus 0%).[11] An Eastern Cooperative Oncology Group trial of 135
patients showed that chemotherapy plus radiation provided a better 2-year
survival rate than radiation therapy alone,[12] similar to that shown in the
Radiation Therapy Oncology Group trial.[11] A number of phase II studies have
suggested improved survival with induction chemoradiotherapy followed by
resection when compared with surgery-only historical controls.[13-19]
Approximately 25% of patients achieve a complete pathologic response, albeit in
some series at the cost of increased postoperative morbidity and mortality.
Phase III trials have compared preoperative concurrent chemoradiotherapy to
surgery alone for patients with esophageal cancer.[20-22] A multicenter
prospective randomized trial in which preoperative combined chemotherapy
(cisplatin) and radiation therapy (3,700 cGy in 370 cGy fractions) followed by
surgery was compared to surgery alone in patients with squamous cell carcinoma,
showed no improvement in overall survival and a significantly higher
postoperative mortality (12% versus 4%) in the combined modality arm.[20] In
patients with adenocarcinoma of the esophagus, a single institution phase III
trial demonstrated a modest survival benefit (16 months versus 11 months) for
patients treated with induction chemoradiotherapy consisting of 5-fluorouracil,
cisplatin, and 4,000 cGy (267 cGy fractions) plus surgery over resection
alone.[21] Finally, a single institution trial randomized patients (75% with
adenocarcinoma) to 5-fluorouracil, cisplatin, vinblastine, and radiation
therapy (1.5 Gy twice daily to a total of 45 Gy) plus resection versus
esophagectomy alone.[22] At a median follow-up of over 8 years, there was no
significant difference between the surgery alone and combined modality therapy
with respect to median survival (17.6 months versus 16.9 months), overall
survival (16% versus 30% at 3 years), or disease-free survival (16% versus 28%
at 3 years). Based on the results of these 3 prospective randomized trials,
preoperative chemoradiotherapy should still be considered under clinical
evaluation.
Two randomized trials have also shown no significant overall survival benefit
for postoperative radiation therapy over surgery alone.[23,24] All newly
diagnosed patients should be considered candidates for new therapies and
clinical trials comparing various treatment modalities.
Special attention to nutritional support is indicated in any patient undergoing
treatment of esophageal cancer.
The designations in PDQ that treatments are "standard" or "under clinical
evaluation" are not to be used as a basis for reimbursement determinations.
References:
1. Lerut T, Coosemans W, Van Raemdonck D, et al.: Surgical treatment of
Barrett's carcinoma: correlations between morphologic findings and
prognosis. Journal of Thoracic and Cardiovascular Surgery 107(4):
1059-1066, 1994.
2. Ginsberg RJ: Cancer treatment in the elderly. Journal of the American
College of Surgeons 187(4): 427-428, 1998.
3. Ellis FH Jr, Williamson WA, Heatley GJ: Cancer of the esophagus and
cardia: does age influence treatment selection and surgical outcomes?
Journal of the American College of Surgeons 187(4): 345-351, 1998.
4. Saxon RR, Morrison KE, Lakin PC, et al.: Malignant esophageal obstruction
and esophagorespiratory fistula: palliation with a polyethylene-covered
Z-stent. Radiology 202(2): 349-354, 1997.
5. Campbell WR, Taylor SA, Pierce GE, et al.: Therapeutic alternatives in
patients with esophageal cancer. American Journal of Surgery 150(6):
665-668, 1985.
6. Mellow MH, Pinkas H: Endoscopic therapy for esophageal carcinoma with
Nd:Yag laser: prospective evaluation of efficacy, complications, and
survival. Gastrointestinal Endoscopy 30(6): 334-339, 1984.
7. Fleischer D, Sivak MV: Endoscopic Nd-YAG laser therapy as palliation for
esophagogastric cancer: parameters affecting initial outcome.
Gastroenterology 89(4): 827-831, 1985.
8. 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): 1969-1972, 1987.
9. Kelsen DP, Bains M, Burt M: Neoadjuvant chemotherapy and surgery of
cancer of the esophagus. Seminars in Surgical Oncology 6(5): 268-273,
1990.
10. Coia LR, Engstrom PF, Paul AR, et al.: Long-term results of infusional
5-FU, mitomycin-C, and radiation as primary management of esophageal
carcinoma. International Journal of Radiation Oncology, Biology,
Physics 20(1): 29-36, 1991.
11. 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). JAMA: Journal of the American Medical
Association 281(17): 1623-1627, 1999.
12. 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.
International Journal of Radiation Oncology, Biology, Physics 42(2):
269-276, 1998.
13. Forastiere AA, Orringer MB, Perez-Tamayo C, et al.: Preoperative
chemoradiation followed by transhiatal esophagectomy for carcinoma of
the esophagus: final report. Journal of Clinical Oncology 11(6):
1118-1123, 1993.
14. Poplin E, Fleming T, Leichman L, et al.: Combined therapies for squamous
cell carcinoma of the esophagus, a Southwest Oncology Group Study
(SWOG-8037). Journal of Clinical Oncology 5(4): 622-628, 1987.
15. Stewart JR, Hoff SJ, Johnson DH, et al.: Improved survival with
neoadjuvant therapy and resection for adenocarcinoma of the esophagus.
Annals of Surgery 218(4): 571-578, 1993.
16. Urba SG, Orringer MB, Perez-Tamayo C, et al.: Concurrent preoperative
chemotherapy and radiation therapy in localized esophageal
adenocarcinoma. Cancer 69(2): 285-291, 1992.
17. Stahl M, Wilke H, Fink U, et al.: Combined preoperative chemotherapy and
radiotherapy in patients with locally advanced esophageal cancer:
interim analysis of a phase II trial. Journal of Clinical Oncology
14(3): 829-837, 1996.
18. Bates BA, Detterbeck FC, Bernard SA, et al.: Concurrent radiation therapy
and chemotherapy followed by esophagectomy for localized esophageal
carcinoma. Journal of Clinical Oncology 14(1): 156-163, 1996.
19. Lew JI, Gooding WE, Ribeiro U, et al.: Long-term survival following
induction chemoradiotherapy and esphagectomy for esophageal carcinoma.
Archives of Surgery 136(7): 737-742, 2001.
20. Bosset JF, Gignoux M, Triboulet JP, et al.: Chemoradiotherapy followed by
surgery compared with surgery alone in squamous-cell cancer of the
esophagus. New England Journal of Medicine 337(3): 161-167, 1997.
21. Walsh TN, Noonan N, Hollywood D, et al.: A comparison of multimodal
therapy and surgery for esophageal adenocarcinoma. New England Journal
of Medicine 335(7): 462-467, 1996.
22. Urba SG, Orringer MB, Turrisi A, et al.: Randomized trial of preoperative
chemoradiation versus surgery alone in patients with locoregional
esophageal carcinoma. Journal of Clinical Oncology 19(2): 305-313,
2001.
23. Teniere 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.
Surgery, Gynecology and Obstetrics 173(2): 123-130, 1991.
24. Fok M, Sham JS, Choy D, et al.: Postoperative radiotherapy for carcinoma
of the esophagus: a prospective, randomized controlled study. Surgery
113(2): 138-147, 1993.
** STAGE 0 ESOPHAGEAL CANCER **
Stage 0 squamous esophageal cancer is rarely seen in the United States, but
surgery has been used for this stage of cancer.[1,2]
References:
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): 1225-1229, 1994.
2. Heitmiller RF, Redmond M, Hamilton SR: Barrett's esophagus with
high-grade dysplasia. An indication for prophylactic esophagectomy.
Annals of Surgery 224(1): 66-71, 1996.
** STAGE I ESOPHAGEAL CANCER **
Standard treatment options:
Surgery.
Treatment options under clinical evaluation:
Clinical trials as outlined in treatment overview. Information about ongoing
clinical trials is available from the NCI (http://cancer.gov/clinical_trials).
** STAGE II ESOPHAGEAL CANCER **
Standard treatment options:
Surgery.
Treatment options under clinical evaluation:
Chemotherapy plus radiation therapy with or without subsequent surgery.[1,2]
Information about ongoing clinical trials is available from the NCI
(http://cancer.gov/clinical_trials).
References:
1. 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). JAMA: Journal of the American Medical
Association 281(17): 1623-1627, 1999.
2. Herskovic A, Al-Sarraf M: Combination of 5-fluorouracil and radiation in
esophageal cancer. Seminars in Radiation Oncology 7(4): 283-290, 1997.
** STAGE III ESOPHAGEAL CANCER **
Standard treatment options:
Surgical resection of T3 lesions.
Treatment options under clinical evaluation:
Chemotherapy plus radiation therapy with or without subsequent surgery.[1,2]
Information about ongoing clinical trials is available from the NCI
(http://cancer.gov/clinical_trials).
References:
1. 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). JAMA: Journal of the American Medical
Association 281(17): 1623-1627, 1999.
2. Herskovic A, Al-Sarraf M: Combination of 5-fluorouracil and radiation in
esophageal cancer. Seminars in Radiation Oncology 7(4): 283-290, 1997.
** STAGE IV ESOPHAGEAL CANCER **
At diagnosis, approximately 50% of patients with esophageal cancer will have
metastatic disease and will be candidates for palliative therapy.[1]
Standard treatment options:
1. Endoscopic-placed stents to provide palliation of dysphagia.[2]
2. Radiation therapy with or without intraluminal intubation and dilation.
3. Intraluminal brachytherapy can also provide palliation of dysphagia.[3,4]
4. Nd:YAG endoluminal tumor destruction or electrocoagulation.[5]
5. Chemotherapy has provided partial responses for patients with metastatic
distal esophageal adenocarcinomas.[6]
Treatment options under clinical evaluation:
Many agents are active in esophageal cancer. Objective response rates of 30%
to 50% and median survivals of less than 1 year are commonly reported with
platinum-based combination regimens with fluorouracil, a taxane, or a
topoisomerase inhibitor.[1]
Clinical trials evaluating single-agent or combination chemotherapy.
Information about ongoing clinical trials is available from the NCI
(http://cancer.gov/clinical_trials).
References:
1. Enzinger PC, Ilson DH, Kelsen DP: Chemotherapy in esophageal cancer.
Seminars in Oncology 26(5, suppl 15): 12-20, 1999.
2. Baron TH: Expandable metal stents for the treatment of cancerous
obstruction of the gastrointestinal tract. New England Journal of
Medicine 344(22): 1681-1687, 2001.
3. Sur RK, Donde B, Levin VC, et al.: Fractionated high dose rate
intraluminal brachytherapy in palliation of advanced esophageal cancer.
International Journal of Radiation Oncology, Biology, Physics 40(2):
447-453, 1998.
4. Gaspar LE, Nag S, Herskovic A, et al.: American Brachytherapy Society
(ABS) consensus guidelines for brachytherapy of esophageal cancer.
International Journal of Radiation Oncology, Biology, Physics 38(1):
127-132, 1997.
5. Bourke MJ, Hope RL, Chu G, et al.: Laser palliation of inoperable
malignant dysphagia: initial and at death. Gastrointestinal Endoscopy
43(1): 29-32, 1996.
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. British Journal of Cancer 80(1/2): 269-272, 1999.
** RECURRENT ESOPHAGEAL CANCER **
All recurrent esophageal cancer patients present difficult problems in
palliation. All patients, whenever possible, should be considered candidates
for clinical trials as outlined in treatment overview.
Standard treatment options:
Palliative use of any of the standard therapies, including supportive care.
Treatment options under clinical evaluation:
Clinical trials as outlined in treatment overview. Information about ongoing
clinical trials is available from the NCI (http://cancer.gov/clinical_trials).
Date Last Modified: 07/2002
******************************************************************************
* This information from PDQ is reviewed regularly by members of the PDQ *
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* information, direct them to: PDQ Editorial Board, CIPS/NCI, 6116 *
* Executive Boulevard, Suite 3002B, MSC-8321, 20892-8321, fax: 301-480-8105.*
* *
* The PDQ database also contains listings of clinical trial protocols and *
* directories of organizations and physicians who treat cancer patients, *
* but this information is not available through CancerMail. For more *
* information on accessing PDQ, consult the CancerMail Contents List. *
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