Esophageal cancer medical therapy: Difference between revisions
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If the patient cannot swallow at all, a [[stent]] may be inserted to keep the esophagus patent; stents may also assist in occluding fistulas. A [[nasogastric tube]] may be necessary to continue feeding while treatment for the tumor is given, and some patients require a [[gastrostomy]] (feeding hole in the skin that gives direct access to the stomach). The latter two are especially important if the patient tends to aspirate food or saliva into the airways, predisposing for [[aspiration pneumonia]]. | If the patient cannot swallow at all, a [[stent]] may be inserted to keep the esophagus patent; stents may also assist in occluding fistulas. A [[nasogastric tube]] may be necessary to continue feeding while treatment for the tumor is given, and some patients require a [[gastrostomy]] (feeding hole in the skin that gives direct access to the stomach). The latter two are especially important if the patient tends to aspirate food or saliva into the airways, predisposing for [[aspiration pneumonia]]. | ||
[[Image:SEMS endo.jpg|thumb|left|150px|[[Self-expandable metallic stent]]s are used for the [[palliative care|palliation]] of esophageal cancer]] | |||
[[Image:SEMS endo.jpg|thumb|left|150px|[[Self-expandable metallic stent]]s are used for the [[palliative care|palliation]] of esophageal cancer]] | [[Image:esophagael stent.jpg|thumb|left|Shows cancer blocking esophagus. Insets show enlarged area of cancer and a stent placed in the esophagus to keep it open.]] | ||
[[Image:esophagael stent.jpg|thumb|left|Shows cancer blocking esophagus. Insets show enlarged area of cancer and a stent placed in the esophagus to keep it open.]] | |||
===Chemotherapy=== | ===Chemotherapy=== | ||
[[Chemotherapy]] depends on the tumor type, but tends to be [[cisplatin]]-based (or [[carboplatin]] or [[oxaliplatin]]) every three weeks with [[fluorouracil]] (5-FU) either continuously or every three weeks. In more recent studies, addition of [[epirubicin]] (ECF) was better than other comparable regimens in advanced nonresectable cancer.<ref>Ross P, Nicolson M, Cunningham D, Valle J, Seymour M, Harper P, Price T, Anderson H, Iveson T, Hickish T, Lofts F, Norman A. Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) with epirubicin, cisplatin, and PVI 5-FU in advanced esophagogastric cancer. ''J Clin Oncol'' 2002;20:1996-2004. PMID 11956258.</ref> Chemotherapy may be given after surgery (adjuvant, i.e. to reduce risk of recurrence), before surgery (neoadjuvant) or if surgery is not possible; in this case, cisplatin and 5-FU are used. Ongoing trials compare various combinations of chemotherapy; the phase II/III REAL-2 trial - for example - compares four regimens containing [[epirubicin]] and either [[cisplatin]] or [[oxaliplatin]] and either continuously infused fluorouracil or [[capecitabine]]. | [[Chemotherapy]] depends on the tumor type, but tends to be [[cisplatin]]-based (or [[carboplatin]] or [[oxaliplatin]]) every three weeks with [[fluorouracil]] (5-FU) either continuously or every three weeks. In more recent studies, addition of [[epirubicin]] (ECF) was better than other comparable regimens in advanced nonresectable cancer.<ref>Ross P, Nicolson M, Cunningham D, Valle J, Seymour M, Harper P, Price T, Anderson H, Iveson T, Hickish T, Lofts F, Norman A. Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) with epirubicin, cisplatin, and PVI 5-FU in advanced esophagogastric cancer. ''J Clin Oncol'' 2002;20:1996-2004. PMID 11956258.</ref> Chemotherapy may be given after surgery (adjuvant, i.e. to reduce risk of recurrence), before surgery (neoadjuvant) or if surgery is not possible; in this case, cisplatin and 5-FU are used. Ongoing trials compare various combinations of chemotherapy; the phase II/III REAL-2 trial - for example - compares four regimens containing [[epirubicin]] and either [[cisplatin]] or [[oxaliplatin]] and either continuously infused fluorouracil or [[capecitabine]]. | ||
Revision as of 14:25, 14 September 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
General approaches
The treatment is determined by the cellular type of cancer (adenocarcinoma or squamous cell carcinoma vs other types), the stage of the disease, the general condition of the patient and other diseases present. On the whole, adequate nutrition needs to be assured, and adequate dental care is vital.
If the patient cannot swallow at all, a stent may be inserted to keep the esophagus patent; stents may also assist in occluding fistulas. A nasogastric tube may be necessary to continue feeding while treatment for the tumor is given, and some patients require a gastrostomy (feeding hole in the skin that gives direct access to the stomach). The latter two are especially important if the patient tends to aspirate food or saliva into the airways, predisposing for aspiration pneumonia.
Chemotherapy
Chemotherapy depends on the tumor type, but tends to be cisplatin-based (or carboplatin or oxaliplatin) every three weeks with fluorouracil (5-FU) either continuously or every three weeks. In more recent studies, addition of epirubicin (ECF) was better than other comparable regimens in advanced nonresectable cancer.[1] Chemotherapy may be given after surgery (adjuvant, i.e. to reduce risk of recurrence), before surgery (neoadjuvant) or if surgery is not possible; in this case, cisplatin and 5-FU are used. Ongoing trials compare various combinations of chemotherapy; the phase II/III REAL-2 trial - for example - compares four regimens containing epirubicin and either cisplatin or oxaliplatin and either continuously infused fluorouracil or capecitabine.
Radiotherapy
Radiotherapy is given before, during or after chemotherapy or surgery, and sometimes on its own to control symptoms. In patients with localised disease but contraindications to surgery, "radical radiotherapy" may be used with curative intent.
Follow-up
Patients are followed up frequently after a treatment regimen has been completed. Frequently, other treatments are necessary to improve symptoms and maximize nutrition.
References
- ↑ Ross P, Nicolson M, Cunningham D, Valle J, Seymour M, Harper P, Price T, Anderson H, Iveson T, Hickish T, Lofts F, Norman A. Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) with epirubicin, cisplatin, and PVI 5-FU in advanced esophagogastric cancer. J Clin Oncol 2002;20:1996-2004. PMID 11956258.