From the Guidelines
Management of Esophageal Cancer with Pulmonary Metastases
For patients presenting with esophageal cancer and lung metastases, a multidisciplinary approach is recommended, with initial treatment typically involving systemic therapy. Chemotherapy regimens such as fluorouracil (5-FU) and cisplatin are commonly used options 1. The choice of regimen should be based on the patient's performance status, comorbidities, and toxicity profile, with two-drug cytotoxic regimens preferred for patients with advanced disease due to lower toxicity 1.
- Chemotherapy: Regimens like fluorouracil (5-FU) 1000 mg/m²/day on days 1-4, and cisplatin 80 mg/m² on day 1, repeated every 28 days for 4-6 cycles, can be considered 1.
- Targeted Therapy: Agents like trastuzumab can be added to chemotherapy if the tumor overexpresses HER2-neu, particularly in metastatic adenocarcinoma 1.
- Radiation Therapy: May be employed for palliative purposes, such as relieving dysphagia or chest pain, with doses ranging from 30-50 Gy in 10-15 fractions 1.
- Palliative Care: Single-dose brachytherapy may be a preferred option for relieving dysphagia, with fewer complications than metal stent placement 1.
The management of esophageal cancer with pulmonary metastases should be individualized, taking into account the patient's overall health, tumor histology, and molecular profiling 1. Regular follow-up visits should focus on symptoms, nutrition, and psycho-social problems 1.
From the FDA Drug Label
• adult patients with unresectable advanced or metastatic esophageal squamous cell carcinoma as first-line treatment in combination with fluoropyrimidine- and platinum‑containing chemotherapy. • adult patients with unresectable advanced or metastatic esophageal squamous cell carcinoma as first-line treatment in combination with ipilimumab. • adult patients with unresectable advanced, recurrent or metastatic esophageal squamous cell carcinoma (ESCC) after prior fluoropyrimidine- and platinum-based chemotherapy.
The management of esophageal cancer with pulmonary metastases may involve nivolumab (IV) in combination with other treatments.
- For unresectable advanced or metastatic esophageal squamous cell carcinoma, nivolumab can be used as a first-line treatment in combination with fluoropyrimidine- and platinum‑containing chemotherapy or ipilimumab.
- For unresectable advanced, recurrent or metastatic esophageal squamous cell carcinoma (ESCC), nivolumab can be used after prior fluoropyrimidine- and platinum-based chemotherapy. 2
From the Research
Management of Esophageal Cancer with Pulmonary Metastases
- The management of esophageal cancer with pulmonary metastases is a complex issue, and the optimal treatment approach is not well established 3.
- However, some studies suggest that pulmonary metastasectomy may provide benefits in selected patients with esophageal squamous cell carcinoma and isolated lung metastases 3.
- A study published in the Journal of Cardiothoracic Surgery found that patients who received pulmonary metastasectomy had significantly better overall survival and progression-free survival compared to those who received only systemic treatment 3.
- The role of radiotherapy in the management of esophageal cancer with pulmonary metastases is also being explored, with some studies suggesting that higher radiation doses may improve local tumor control and survival 4.
- Chemoradiotherapy is currently the standard treatment for locally advanced esophageal cancer, and the addition of chemotherapy to radiotherapy has been shown to improve survival rates 5, 6.
Treatment Options
- Pulmonary metastasectomy: may be considered in selected patients with esophageal squamous cell carcinoma and isolated lung metastases 3.
- Chemoradiotherapy: is the standard treatment for locally advanced esophageal cancer, and may be effective in managing esophageal cancer with pulmonary metastases 5, 6.
- Systemic therapy: such as chemotherapy, may be used to manage esophageal cancer with pulmonary metastases, especially in patients who are not candidates for surgery or radiotherapy 3, 7.
Prognostic Factors
- Clinical nodal stage: has been identified as a significant prognostic factor for progression-free survival in patients with esophageal cancer treated with definitive chemoradiotherapy 6.
- Tumor length and gross tumor volume: have also been identified as prognostic factors for overall survival and progression-free survival in patients with esophageal cancer 6.