More Options, Better Outcomes
In the last 10 to 20 years, treatment for esophageal cancer patients drastically improved. Dr. Demmy explains the new standard of care.
After the multidisciplinary conference where the surgical, medical and radiation oncologists, plus other esophageal cancer experts, review your individual case, the team will determine which treatment option is best for you. This decision will depend on:
- Where in the esophagus the cancer is located
- Whether the cancer has invaded nearby structures
- Whether the cancer has spread to lymph nodes or other organs
- Your symptoms
- Your general health
Your treatment plan will likely include one or more of the following approaches:
Esophagectomy, open, minimally invasive laparoscopic and thoracoscopic: Surgical results and outcomes depend upon the surgeons’ experience and how many of the surgeries are performed at the facility. RPCI is a high volume center for esophageal surgery with very experienced surgeons in both minimally invasive and open esophageal resection.
- Endoscopic mucosal resection: A minimally-invasive surgical procedure to remove superficial abnormal lesions or tissue. The procedure, performed under local anesthesia and sedative, involves lifting esophageal lining and injecting a solution underneath or applying suction, and cutting the lining off, which is then removed with an endoscope. This treatment may be used in combination with photodynamic therapy and is for patients whose cancer involves only the top layer of esophageal cells.
- Electrocoagulation: Uses heat to destroy cancer cells in the esophagus. This treatment may also be used to manage symptoms that make it difficult to swallow or eat.
- Stents and balloon dilation: These treatments help address problems with swallowing and eating when the cancer blocks the esophagus. A stent is a small mesh or plastic tube inserted in the esophagus, which allows foods and liquids to pass more easily. A balloon dilation involves using a balloon to help widen the esophagus.
When radiation therapy is part of the treatment for esophageal cancer, it is often given along with chemotherapy before surgery to improve the outcome of surgical treatment. If surgery is done initially, some patients may need radiation therapy afterwards. Radiation therapy may also be used as palliative care to ease cancer symptoms.
Radiation therapy for esophageal cancers may be delivered in different ways, including:
- External Beam Radiation Therapy (EBRT): This is the most common method of delivering radiation for treatment of esophageal cancer. Radiation is usually delivered over 25 to 28 treatments and can be done in several ways, each with their own advantages.
- 3-Dimensional Conformal Radiation Therapy (3D CRT): This is a form of EBRT where a few shaped radiation beams are aimed at the cancer target from different directions.
- Volumetric Modulated Arc Therapy (VMAT): A more precise form of EBRT than 3D CRT where the radiation dose is given and the field shape is changed continuously as the treatment machine moves, or arcs, around the patient. This treatment helps to spare more normal tissue.
- Stereotactic Body Radiation Therapy (SBRT): This is similar to VMAT in that it is planned with great precision, but the difference is that the entire radiation dose is given over a fewer number of treatments, typically about five. The RPCI radiation medicine team goes to great lengths to achieve the necessary precision needed to target the cancer while protecting normal tissue and organs, including the gating technique which holds the patient still and reduces movement from breathing.
Treatment of esophageal cancer involves multimodality approach. Medical therapy using various chemotherapeutic agents is usually an integral component of treatment plan.
The basis of chemotherapy is the use of agents that kill cancer cells by interrupting and preventing rapidly-dividing cells (like cancer cells) from multiplying. Agents used in esophageal cancer are delivered intravenously (through an IV) as well as taken orally. The regimen that’s chosen for a particular patient is based on various factors, such as the cancer’s stage and whether the patient has any other medical conditions. As esophageal cancer treatment may involve a multimodality approach, coordination with other specialties and close monitoring for side effects is vital.
Just as no two cancer patients are exactly alike, the same can be said for their cancers. Each tumor is genetically different from another, and these differences can translate to one patient responding to treatment while another does not. We determine which patients will benefit from drugs like trastuzumab, the only FDA approved targeted agent HER2 Neu over-expressing esophageal cancer, sparing others the costs and side effects of a treatment unlikely to help them, and directing them to a more appropriate option.