From the Guidelines
The initial treatment recommendation for a patient with esophageal cancer is a multidisciplinary approach, with the specific treatment depending on the stage of disease, and for locally advanced disease, a combination of chemotherapy and radiation therapy (chemoradiation) is usually recommended before surgery, as supported by the most recent and highest quality study 1.
Key Considerations
- For early-stage disease (stages I-II), surgical resection is often the primary treatment, which may include esophagectomy with lymph node removal.
- For locally advanced disease (stage III), a combination of chemotherapy and radiation therapy (chemoradiation) is usually recommended before surgery, commonly using regimens such as carboplatin and paclitaxel with concurrent radiation, or cisplatin and 5-fluorouracil.
- For metastatic disease (stage IV), systemic chemotherapy is the mainstay of treatment, often with platinum-based combinations.
- Before finalizing treatment plans, patients should undergo comprehensive staging with endoscopic ultrasound, CT scans, and possibly PET scans to accurately determine the extent of disease.
- Nutritional support is crucial throughout treatment, and may require feeding tube placement in some cases.
- The treatment approach should be tailored to the patient's overall health status, tumor histology (adenocarcinoma vs. squamous cell carcinoma), and location of the tumor, as these factors significantly impact both treatment selection and prognosis.
Treatment Approach
- Multimodality therapy should be offered to patients with locally advanced esophageal carcinoma, as recommended by the ASCO guideline 1.
- Preoperative chemoradiotherapy (CRT) or perioperative chemotherapy (CT) should be offered to patients with locally advanced esophageal adenocarcinoma, as recommended by the ASCO guideline 1.
- The FLOT regimen, which includes 4 preoperative and 4 postoperative 2-week cycles of 50 mg/m2 docetaxel, 85 mg/m2 oxaliplatin, 200 mg/m2 leucovorin, and 2,600 mg/m2 fluorouracil as 24-hour infusion on day 1, is recognized as the standard of care for perioperative CT in esophageal adenocarcinoma 1.
From the Research
Initial Referral Treatment Recommendation for Esophageal Cancer
The initial treatment recommendation for a patient with esophageal cancer depends on the stage and severity of the disease.
- For patients with early-stage esophageal cancer, endoscopic resection (ER) or surgical resection may be recommended 2.
- For patients with locally advanced esophageal cancer, a multidisciplinary approach is often used, which may include neoadjuvant chemoradiotherapy, definitive chemoradiotherapy, or upfront surgery 3, 4.
- The treatment plan should be discussed in a multidisciplinary conference to determine the best course of action for the patient, taking into account the stage of the disease and the patient's overall health 5.
- Immunotherapy may also be considered for certain patients with esophageal cancer 2.
Treatment Options
- Surgical resection: may be recommended for patients with early-stage or locally advanced esophageal cancer 2, 3.
- Endoscopic resection (ER): may be recommended for patients with early-stage esophageal cancer 2.
- Chemoradiotherapy: may be recommended for patients with locally advanced esophageal cancer, either as neoadjuvant treatment before surgery or as definitive treatment 3, 4.
- Immunotherapy: may be considered for certain patients with esophageal cancer 2.
Multidisciplinary Approach
- A multidisciplinary approach is essential for the management of esophageal cancer, involving a team of healthcare professionals including surgeons, oncologists, radiologists, and other specialists 3, 5, 4, 6.
- The treatment plan should be discussed in a multidisciplinary conference to determine the best course of action for the patient 5.