Esophageal Cancer

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.