Treatment

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Chemotherapy is another method of treating esophageal cancer used alone or in combination with radiation therapy and/or surgery. ^{1 2 3} For patients who are not candidates for surgery, chemotherapy and radiation therapy (also called chemoradiation) may be recommended without surgery.

When given alone or in combination with radiation therapy, chemotherapy may also be used to relieve symptoms of advanced cancer, such as difficulty with swallowing, and for the treatment of advanced metastatic disease that has spread to other areas of the body.

The drugs commonly used to treat esophageal cancer include 5-fluorouracil, cisplatin, carboplatin, oxaliplatin, paclitaxel, docetaxel, irinotecan, capecitabine, and mitomycin. Some of these drugs are given intravenously and some orally. This therapy is known as a systemic therapy, meaning that chemotherapy drugs travel through the blood to cells all over the body.

Investigators at Memorial Sloan-Kettering continue to identify novel therapeutic drugs to improve the care of patients with esophageal cancer. For example, the newer targeted therapy agents, including bevacizumab and cetuximab, as well as new combinations of conventional drugs are currently under investigation at the Center.

Radiation Therapy

Radiation therapy is most commonly used in combination with chemotherapy to treat esophageal cancer. It is usually administered before surgery, rather than after surgery. Radiation therapy may also be used to relieve pain, enhance swallowing, or treat other symptoms of esophageal cancer. When radiation therapy is used to treat esophageal cancer, the doctor may insert a plastic or metal tube into the esophagus to keep it open -- a procedure called stenting.

At Memorial Sloan-Kettering, we are involved in a number of clinical trials being designed and run by our own physicians. We also are involved with national trials through organizations such as the Radiation Therapy Oncology Group (RTOG) and the Cancer and Acute Leukemia Group B (CALGB), investigating new combinations of chemotherapy and radiation therapy.

Our doctors are involved in ongoing efforts to decrease the toxicity, or damage, to healthy tissues that may occur during radiation therapy for esophageal cancer. Intensity-modulated radiation therapy (IMRT) and respiratory gating are two approaches that have potential merit in decreasing toxicity to normal tissue.

IMRT is a type of 3-D radiation therapy that targets tumors with greater precision than conventional radiation therapy. Using highly sophisticated computer software and 3-D images from CT scans, the radiation oncologist can develop an individualized treatment plan that delivers high doses of radiation to cancerous tissue while sparing surrounding organs and reducing the risk of injury to healthy tissues.

Respiratory gating is another type of radiation therapy used at Memorial Sloan-Kettering to treat esophageal cancer with minimal damage to healthy tissue. Because tumors and organs in the abdomen shift during breathing, precise delivery of radiation therapy to cancerous tissue can be difficult. Respiratory gating entails the delivery of radiation treatment only at certain points during a patient's breathing cycle, when the "mobile" tumors and/or regions of the abdomen are in a specific position. This approach decreases the radiation dose to the surrounding healthy tissues. Respiratory gating is particularly important for tumors at the gastroesophageal junction, where there is a lot of motion due to breathing.

Patients with esophageal cancer may also receive treatment that is not curative but relieves their pain and other symptoms -- this is known as palliative treatment.

• Stenting

  A surgeon or gastroenterologist may implant a metal mesh device called a stent into the esophagus near the tumor to help keep the esophagus open. Stents may enhance swallowing and enable a patient to continue eating a nutritious diet.

• Radiation Therapy

  Our doctors often help patients with obstructive symptoms using a short course of radiation therapy to help shrink the tumor and reduce the obstruction, which allows patients to eat. Radiation therapy may also be used after stenting to keep the stent open and unobstructed.

• Photodynamic Therapy

  Photodynamic therapy is another option for some patients with esophageal cancer and is used primarily for relieving discomfort. This form of therapy is approved for the relief of esophageal obstruction and is being investigated for treating early cancers of the esophagus. It is also used to relieve swallowing difficulties.

  During a photodynamic therapy procedure, the patient receives an injection of a special light-sensitive drug that collects in the tumor. The doctor then shines a laser light on the esophageal tissue using an endoscope. The light activates the drug that has collected in the cancer tissue and enables it to kill cancer cells. Because the drug collects only in cancerous tissue, normal tissue is spared from the drug's side effects.

  Some patients need to follow a liquid or soft diet during treatment for esophageal cancer, particularly when the tumor causes significant obstruction in the esophagus. In other patients, a feeding tube that delivers food into the stomach may be implanted outside the abdomen. This is usually temporary and is sometimes required during chemotherapy and radiation therapy, when some patients have trouble eating.

• Laser Therapy

  Patients whose tumors are partially blocking the esophagus may benefit from laser therapy performed during endoscopy. In this procedure, the doctor uses an endoscope to aim laser beams at the cancer, sparing the patient from an external surgical incision. Because the cancer can continue to grow back, our doctors may need to have laser endoscopy repeated every six to eight weeks in order to continue to relieve the obstruction.

  Because the cancer may grow around certain nerves, patients with esophageal cancer may experience pain. If you are experiencing pain, be sure to tell your doctor so that you can receive pain-relieving medication.