Esophageal Cancer

SAN DIEGO-Although there are some families that have a high prevalence of Barrett’s esophagus, the disease is more frequently sporadic, Yvonne Romero, MD, of the Mayo Clinic, reported at the annual meeting of the American Gastroenterological Association, held during the Digestive Disease Week conference. She and her colleagues studied symptomatic relatives of Barrett’s esophagus patients to determine if family relationships could help predict the disease.

PHOENIX-A more aggressive endoscopic biopsy protocol detected more early cancers in Barrett’s esophageal tissue than the standard protocol. Moreover, two separate studies have begun to identify specific genetic markers that may allow physicians to stratify patients with Barrett’s esophagus according to their risk for cancer progression.

Esophageal cancer poses an interesting challenge for oncologists. Esophageal squamous cell cancer has the most varied geographical incidence of any cancer, suggesting the existence of critically important environmental and molecular epidemiologic factors. These factors remain largely unrecognized.

Esophageal cancer is a relatively rare but deadly cancer in the United States. Even in patients with limited locoregional disease at the time of diagnosis, who have received aggressive multimodality therapies as part of clinical protocols, median survival is only 17 months and 3-year survival, only 30%.[1,2] Patients with metastatic disease have a 6-month median survival, which is not improved by the administration of chemotherapy.

Esophageal cancer, with an estimated number of 12,300 new cases in the year 2000, is relatively uncommon in the United States but produces a high number of annual deaths, estimated at 12,100. Moreover, the incidence of the

Dr. Minsky’s two-part review of primary and adjuvant treatment of esophageal cancer is current and comprehensive. In it, he details our present understanding of esophageal cancer management by reviewing the most important studies conducted over the past 2 decades.

Dr. Minsky provides an excellent review of the current status of primary and adjuvant therapy in patients with carcinoma of the esophagus. Although the treatment of esophageal cancer remains a hotly debated issue, recent results clearly show the superiority of combined-modality therapy, especially when surgical resection is not planned.

The two general treatment approaches for esophagel cancer are primary treatment (surgical or nonsurgical) or adjuvant treatment (preoperative or postoperative). Due to differences in the patient populations selected for surgical or nonsurgical therapies, which may bias the results against nonsurgical therapy, it is difficult to determine the best treatment approach for this disease. The standard of care is either surgery alone or primary combined-modality therapy. Based on a nonrandomized comparison of the data from recent intergroup trials, the results of these two approaches are similar. For patients treated without surgery, the intergroup INT 0123 trial will determine whether higher doses of radiation are of benefit. No clear survival advantage has been seen with preoperative or postoperative adjuvant radiation therapy alone or chemotherapy alone. The randomized trials comparing preoperative combined-modality therapy vs surgery alone reveal encouraging results for the combination approach but need further confirmation. For patients treated with combined-modality therapy, the ideal regimen remains to be determined. Part 1 of this two-part review, which appeared in last month’s issue, centered on primary therapy for esophageal carcinoma. This part explores the rationale for and results of adjuvant therapy. [ONCOLOGY 13(10):1415-1427,1999]

The two general treatment approaches for esophagel cancer include primary treatment (surgical or nonsurgical) or adjuvant treatment (preoperative or postoperative). Due to differences in the patient populations selected for

Photodynamic therapy (PDT) relieves swallowing problems associated with esophageal cancer in the majority of patients treated, according to a study conducted from November 1996 to June 1998 at the University of Pittsburgh Cancer Institute.

For patients with high-grade dysplasia associated with Barrett’s esophagus or adenocarcinoma, photodynamic therapy

NEW YORK-Preliminary data presented at the Chemotherapy Foundation Symposium XVI suggest that the toposiomerase I inhibitor irinotecan (Camptosar) in combination with other chemotherapy agents may be effective in multiple tumor types, including advanced non-small-cell lung cancer (NSCLC) and advanced esophageal cancer.

NASHVILLE--Combined neoadjuvant therapy with paclitaxel (Taxol), carboplatin (Paraplatin), fluorouracil (5-FU), and irradiation, followed by surgery, resulted in complete pathologic responses in almost half of a group of patients with advanced esophageal cancer.

NEW ORLEANS--A diet rich in black raspberries prevented chemically induced esophageal tumors in rats, Laura Ann Kresty, MS, reported at the American Association for Cancer Research annual meeting. Ms. Kresty is a PhD graduate student at Ohio State University College of Medicine and Public Health, working in the laboratory of Gary D. Stoner, PhD, professor and chair of the Environmental Health Sciences Division.

BUFFALO, NY--In January 1998, the Food and Drug Administration approved photodynamic therapy (PDT) using the sensitizer porfimer sodium (Photofrin) for the treatment of early-stage lung cancer. PDT was originally approved in 1995 for the palliative treatment of obstructive esophageal cancer.

BUFFALO, NY-Photofrin (porfi-mer sodium), a photosensitizer used in photodynamic therapy (PDT), has received FDA approval for use in early-stage microinvasive lung cancer. The agent, manufactured by QLT Photo-Therapeutics, was approved in 1995 for palliative use in esophageal cancer.

The use of chemotherapy and radiotherapy prior to surgery for patients with potentially resectable esophageal carcinoma has been investigated since the late 1970s, with trials yielding response rates approaching 50%.

The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative extent of disease evaluation, and the role of the surgeon in

Using positron emission tomography (PET) scanning may improve the treatment of patients with cancer of the esophagus, potentially resulting in lower morbidity, according to surgeons at the University of Pittsburgh Medical Center.

NIJMEGEN, The Netherlands--With 12,000 new cases of esophageal cancer diagnosed every year in the United States, and 5-year postoperative survival rates still hovering under 20%, the need to develop more effective multimodality treatment strategies remains crucial, said David Ilson, MD, of Memorial Sloan-Kettering Cancer Center.

Drs. Ilson and Kelsen present an excellent review of the current investigations and treatment recommendations for patients with esophageal cancer. In a comprehensive and concise fashion, they detail controversies in surgical and nonsurgical management, neoadjuvant therapies, and regimens for treating metastatic disease. Their review provides an opportunity to further highlight several research questions.

Although therapy for esophageal cancer has generated a profusion of research programs and clinical trials, difficult issues and important questions remain to be addressed and answered. The scholarly, balanced review of esophageal cancer by Drs. Ilson and Kelsen explores these issues and questions in a state-of-the art summary of treatments for this disease. The authors hold impressive credentials in this field: almost all clinical research in esophageal cancer for the past two decades owes some debt to Dr. Kelsen and his colleagues at Memorial Sloan-Kettering Cancer Center. In this commentary, we will utilize a few of the key points raised by the authors to suggest a slightly different perspective on approaches to esophageal cancer treatment and directions for future research endeavors.

The standard approaches of surgery or radiotherapy cure only a minority of patients with esophageal cancer. Because of these poor results and the frequent systemic pattern of recurrences, combined-modality therapy

Dr. Krasna provides a thoughtful review of thoracoscopy as an emerging technique for the staging of patients with lung and esophageal cancers. In lung cancer, thoracoscopy can be used as a complement to cervical mediastinoscopy in the evaluation of mediastinal and hilar lymph nodes. This is especially true in patients who have left-sided neoplasms with enlarged lymph nodes in the aortico-pulmonary window--a region typically inaccessible to cervical mediastinoscopy.

Dr. Krasna provides a well-illustrated review of the applications of thoracoscopy in lung and esophageal tumors. These include: staging of tumors; diagnosis of indeterminate pulmonary nodules; definitive resections of various tumors, especially in cases of poor reserve; and diagnosis and treatment of malignant pleural disease [1]. However, there remains considerable disagreement among thoracic surgical oncologists over the proper applications of these techniques.

Staging is extremely important in determining the proper treatment of patients with thoracic malignancies. Staging groups can be used to predict outcome after cancer treatment and allocate patients to appropriate treatment

WASHINGTON--The FDA has approved QLT PhotoTherapeutics' light-activated drug Photofrin (porfimer sodium) for the palliative treatment of esophageal constriction in patients with advanced esophageal cancer.

African-Americans and Caucasians who have the same type of esophageal cancer and receive the same quality of treatment have a similar survival rate, preliminary results of a national study show.