From the Guidelines
Metastatic esophageal carcinoma should be treated with a multidisciplinary approach, prioritizing chemotherapy as the backbone, with consideration of palliative treatment options such as single-dose brachytherapy, external radiotherapy, or metal stent placement, depending on the clinical situation, as recommended by the most recent guidelines 1.
Treatment Approach
The treatment of metastatic esophageal carcinoma involves a combination of chemotherapy, radiation therapy, and supportive care. Chemotherapy is indicated for palliative treatment in selected patients, particularly those with adenocarcinoma who have a good performance status 1.
- First-line treatment often includes a platinum-based agent (cisplatin or oxaliplatin) combined with a fluoropyrimidine (5-fluorouracil or capecitabine).
- Targeted therapy like trastuzumab may be added for HER2-positive tumors.
- Immunotherapy with pembrolizumab may be used for PD-L1 positive tumors.
Palliative Treatment Options
Palliative treatment options, such as single-dose brachytherapy, external radiotherapy, or metal stent placement, may be considered to relieve symptoms and improve quality of life 1.
- Single-dose brachytherapy may be a preferred option for patients with metastatic oesophageal cancer, as it provides better long-term relief of dysphagia with fewer complications than metal stent placement.
- External radiotherapy or metal stent placement may also be used to palliate symptoms.
Supportive Care
Supportive care is crucial in the management of metastatic esophageal carcinoma, including pain management, nutritional support, and psychological support 1.
- Nutritional support, possibly requiring feeding tubes, may be necessary to maintain adequate nutrition.
- Psychological support is essential to address the emotional and psychological needs of patients with metastatic disease.
Prognosis and Treatment Goals
The prognosis for metastatic esophageal carcinoma is generally poor, with a median survival of 8-12 months, although this varies based on disease extent, patient performance status, and response to therapy 1.
- Treatment goals focus on extending survival while maintaining quality of life, with regular assessments to monitor response and adjust therapy as needed.
From the Research
Metastatic Esophageal Carcinoma
- Metastatic esophageal carcinoma is a type of cancer that has spread to other parts of the body, and its treatment aims to control symptoms, improve quality of life, and prolong survival 2, 3, 4, 5, 6.
- Platinum-based chemotherapy is considered a standard treatment option for patients with metastatic esophageal carcinoma, but the overall survival of patients receiving such treatment is less than 1 year 2.
- Palliative chemoradiotherapy has been shown to be safe and effective in improving dysphagia in patients with stage IV esophageal cancer, with a response rate of 80% for the primary tumor and 44% for overall response 2.
Treatment Options
- Combination chemotherapy, such as cisplatin and 5-fluorouracil, is associated with higher response rates, but similar survival rates compared to monochemotherapy 3.
- Targeted therapies, such as ramucirumab, have shown promising results in improving overall survival and progression-free survival in patients with metastatic esophageal cancer 4.
- Palliative external beam radiation therapy, brachytherapy, and chemoradiation regimens can provide palliation of dysphagia in up to 90% of patients, but may be associated with acute toxicity and other complications 5.
- Endoscopic techniques, such as esophageal dilatation, laser therapy, and stent placement, can provide palliation of dysphagia, but may have limitations and complications 5, 6.
Current Evidence and Trends
- Concurrent chemoradiotherapy offers the best outcomes in patients with inoperable non-metastatic cancer who are medically not fit for surgery or have unresectable, locally advanced disease 6.
- Several double-agent or triple-agent chemotherapy regimens have been established as first-line treatment options for distant metastatic oesophageal cancer, and targeted therapies have shown promising results in improving overall survival and progression-free survival 4, 6.
- Self-expandable metal stent (SEMS) placement is currently the most widely applied method for the local treatment of malignant dysphagia, but efforts are being made to develop and evaluate the efficacy of antireflux stents and irradiation stents 6.