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Langenbeck's Archives of Surgery
Erschienen in: Langenbeck's Archives of Surgery 2/2013

01.02.2013 | Review Article

Multimodal treatment of esophageal cancer

verfasst von: Florian Lordick, Arnulf H. Hölscher, Karen Haustermans, Christian Wittekind

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 2/2013

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Abstract

Background

The treatment of localized esophageal cancer has been debated controversially over the past decades. Neoadjuvant treatment was used empirically, but evidence was limited due to the lack of high-quality confirmatory studies. Meanwhile, data have become much clearer due to recently published well-conducted randomized controlled trials and meta-analyses.

Methods

Neoadjuvant and perioperative platinum fluoropyrimidine-based combination chemotherapy has now an established role in the treatment of stage II and stage III esophageal adenocarcinoma and cancer of the esophago-gastric junction. Neoadjuvant chemoradiation is now the standard of care for treating stage II and stage III esophageal squamous cell cancer and can also be considered for treating esophageal adenocarcinoma.

Results

Patients with esophageal squamous cell cancer treated with definitive chemoradiation achieve comparable long-term survival compared with surgery. Short-term mortality is less with chemoradiation alone, but local tumor control is significantly better with surgery.

Conclusion

This expert review article outlines current data and literature and delineates recommendable treatment guidelines for localized esophageal cancer.
Literatur
1.
Natsugoe S, Matsumoto M, Okumura H et al (2005) Multiple primary carcinomas with esophageal squamous cell cancer: clinicopathologic outcome. World J Surg 29:46–49PubMedCrossRef
2.
Lagergreen J (2004) Oesophageal cancer and gastro-oesophageal reflux: what is the relationship? Gut 53:1064–1065CrossRef
3.
Leers JM, Bollschweiler E, Hölscher AH (2005) Refluxanamnese von Patienten mit Adenokarzinom der Speiseröhre. Z Gastroenterol 43:275–280PubMedCrossRef
4.
Hvid-Jensen F, Pedersen L, Drewes AM et al (2011) Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med 365:1375–1383PubMedCrossRef
5.
Kamangar F, Dores GM, Anderson WF (2006) Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 24:2137–2150PubMedCrossRef
6.
Pohl H, Sirovich B, Welch G (2010) Esophageal adenocarcinoma incidence: are we reaching the peak? Cancer Epidemiol Biomarkers Prev 19:1468–1470PubMedCrossRef
7.
Sobin LH, Gospodarowicz MK, Wittekind C (2010) TNM classification of malignant tumours. 7th ed. John Wiley & Sons, Chichester, UK
8.
Camargo MC, Anderson WF, King JB et al (2011) Divergent trends for gastric cancer incidence by anatomical subsite in US adults. Gut 60:1644–1649PubMedCrossRef
9.
Siewert JR, Hölscher AH, Becker K, Gössner W (1987) Kardiacarcinom: Versuch einer therapeutisch relevanten Klassifikation. Chirurg 58:25–32PubMed
10.
Gertler R, Stein HJ, Langer R et al (2011) Long-term outcome of 2920 patients with cancers of the esophagus and esophagogastric junction: evaluation of the New Union Internationale Contre le Cancer/American Joint Cancer Committee staging system. Ann Surg 253:689–698PubMedCrossRef
11.
Hölscher AH, Bollschweiler E, Schröder W, Metzger R, Gutschow C, Drebber U (2011) Prognostic impact of upper, middle, and lower third mucosal or submucosal infiltration in early esophageal cancer. Ann Surg 254:802–807PubMedCrossRef
12.
van Westreenen HL, Westerterp M, Sloof GW et al (2007) Limited additional value of positron emission tomography in staging oesophageal cancer. Br J Surg 94:1515–1520PubMedCrossRef
13.
Hardwick RH, Williams GT (2002) Staging of oesophageal adenocarcinoma. Br J Surg 89:1976–1977CrossRef
14.
Kelly S, Harris KM, Berry E et al (2001) A systematic review of the staging performance of endoscopic ultrasound on gastro-oesophageal carcinoma. Gut 49:534–539PubMedCrossRef
15.
Rösch T (1995) Endosonographic staging of esophageal cancer: a review of literature results. Gastrointest Endosc Clin N Am 5:537–547PubMed
16.
Mönig SP, Schröder W, Baldus SE, Hölscher AH (2000) Preoperative lymph node staging in gastrointestinal cancer – correlation between size and tumour stage. Onkologie 25:342–344
17.
Bartels H, Stein HJ, Siewert JR (1998) Preoperative risk analysis and postoperative mortality of oesophagectomy for resectable oesophageal cancer. Br J Surg 85:840–844PubMedCrossRef
18.
Bollschweiler E, Schröder W, Hölscher AH, Siewert JR (2000) Preoperative risk analysis in patients with adenocarcinoma or squamous cell carcinoma of the oesophagus. Brit J Surg 87:1106–1110PubMedCrossRef
19.
Schröder W, Bollschweiler E, Kossow C, Hölscher A (2006) Preoperative risk analysis—a reliable predictor of postoperative outcome after transthoracic esophagectomy? Langenbecks Arch Surg 391:455–460PubMedCrossRef
20.
Steyerberg EW, Neville BA, Koppert LB et al (2006) Surgical mortality in patients with esophageal cancer: development and validation of a simple risk score. J Clin Oncol 24:4277–4284PubMedCrossRef
21.
Pech O, Bollschweiler E, Manner H et al (2011) Comparison between endoscopic and surgical resection of mucosal esophageal adenocarcinoma in Barrett’s esophagus at two high-volume centers. Ann Surg 254:67–72PubMedCrossRef
22.
Hulscher JBF, Van Sandick JW, De Beure AGEM, van Lanschot J (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. New Engl Med 347:1662–1669CrossRef
23.
Omloo JMT, Lagarde SM, Hulscher JBF et al (2007) Extended transthoracic resection compared with limited transhiatal resection for adneocarcinoma of the mid/distal esophagus: five year survival of a randomized clinical trial. Ann Surg 246:992–1000PubMedCrossRef
24.
Stein HJ, Feith M, Mueller J et al (2000) Limited resection for early adenocarcinoma in Barrett’s esophagus. Ann Surg 232:733–742PubMedCrossRef
25.
Gutschow C, Schröder W, Wolfgarten E, Hölscher AH (2004) Operation nach Merendino mit Vaguserhaltung beim Frühkarzinom des gastroösophagealen Übergangs. Zentralbl Chir 129:276–281PubMedCrossRef
26.
Pech O, Manner H, Ell C (2011) Endoscopic resection. Gastrointest Endosc Clin N Am 21:81–94PubMedCrossRef
27.
Ott K, Bader FG, Lordick F et al (2009) Surgical factors influence the outcome after Ivor–Lewis esophagectomy with intrathoracic anastomosis for adenocarcinoma of the esophagogastric junction: a consecutive series of 240 patients at an experienced center. Ann Surg Oncol 16:1017–1025PubMedCrossRef
28.
Ott K, Lordick F, Molls M et al (2009) Limited resection and free jejunal graft interposition for squamous cell carcinoma of the cervical oesophagus. Br J Surg 96:258–266PubMedCrossRef
29.
Schröder W, Hölscher AH, Bludau M et al (2010) Ivor–Lewis esophagectomy with and without laparoscopic conditioning of the gastric conduit. World J Surg 34:738–743PubMedCrossRef
30.
Mariette C, Piessen G (2012) Oesophageal cancer: how radical should surgery be? Eur J Surg Oncol 38:210–213PubMedCrossRef
31.
Mariette C, Piessen G, Triboulet JP (2007) Therapeutic strategies in oesophageal carcinoma: role of surgery and other modalities. Lancet Oncol 8:545–553PubMedCrossRef
32.
Sjoquist KM, Burmeister BH, Smithers BM et al (2011) Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol 12:681–692PubMedCrossRef
33.
Nygaard K, Hagen S, Hansen HS et al (1992) Pre-operative radiotherapy prolongs survival in operable esophageal carcinoma: a randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second Scandinavian trial in esophageal cancer. World J Surg 16:1104–1109PubMedCrossRef
34.
Lordick F, Stein HJ, Peschel C, Siewert JR (2004) Neoadjuvant therapy for oesophagogastric cancer. Br J Surg 91:540–551PubMedCrossRef
35.
Arnott SJ, Duncan W, Gignoux M, et al (2005) Preoperative radiotherapy for esophageal carcinoma. Cochrane Database Syst Rev (4): CD001799
36.
Kelsen DP, Ginsberg R, Pajak TF et al (1998) Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 339:1979–1984PubMedCrossRef
37.
Medical Research Council Oesophageal Cancer Working Party (2002) Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomized controlled trial. Lancet 359:1727–1733CrossRef
38.
Ychou M, Boige V, Pignon JP et al (2011) Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 29:1715–1721PubMedCrossRef
39.
van Hagen P, Hulshof MC, van Lanschot JJ et al (2012) Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366:2074–2084PubMedCrossRef
40.
Fiorica F, Di Bona D, Schepis F et al (2004) Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis. Gut 53:925–930PubMedCrossRef
41.
Stahl M, Walz MK, Stuschke M et al (2009) Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol 27:851–856PubMedCrossRef
42.
Urschel JD, Vasan H, Blewett CJ (2002) A meta-analysis of randomized controlled trials that compared neoadjuvant chemotherapy and surgery to surgery alone for resectable esophageal cancer. Am J Surg 183:274–279PubMedCrossRef
43.
44.
Greer SE, Goodney PP, Sutton JE, Birkmeyer JD (2005) Neoadjuvant chemoradiation for esophageal carcinoma: a meta-analysis. Surgery 137:172–179PubMedCrossRef
45.
Urschel JD, Vasan H (2003) A meta-analysis of randomised controlled trials that compared neoadjuavnt chemoradiation and surgery alone for resectable esophageal cancer. Am J Surg 185:538–543PubMedCrossRef
46.
Abou-Jawde JM, Mekhail T, Adelstein DJ et al (2005) Impact of induction concurrent chemoradiotherapy on pulmonary function and postoperative acute respiratory complications in esophageal cancer. Chest 128:250–256PubMedCrossRef
47.
Khushalani NI, Leichman CG, Proulx G et al (2002) Oxaliplatin in combination with protracted-infusion fluorouracil and radiation: report of a clinical trial for patients with esophageal cancer. J Clin Oncol 20:2844–2850PubMedCrossRef
48.
Lorenzen S, Brücher B, Zimmermann F et al (2008) Neoadjuvant continuous infusion of weekly 5-fluorouracil and escalating doses of oxaliplatin plus concurrent radiation in locally advanced oesophageal squamous cell carcinoma: results of a phase I/II trial. Br J Cancer 99:1020–1026PubMedCrossRef
49.
Conroy T, Yataghène Y, Etienne PL et al (2010) Phase II randomised trial of chemoradiotherapy with FOLFOX4 or cisplatin plus fluorouracil in oesophageal cancer. Br J Cancer 103:1349–1355PubMedCrossRef
50.
Conroy T, Galais MP, Raoul JL et al (2012) Phase III randomized trial of definitive chemoradiotherapy (CRT) with FOLFOX or cisplatin and fluorouracil in esophageal cancer (EC): Final results of the PRODIGE 5/ACCORD 17 trial. J Clin Oncol 30 (suppl; abstr LBA4003)
51.
Mehta V (2005) Radiation pneumonitis and pulmonary fibrosis in non-small-cell lung cancer: pulmonary function, prediction, and prevention. Int J Radiat Oncol Biol Phys 63:5–24PubMedCrossRef
52.
Ruol A, Rizzetto C, Castoro C et al (2010) Interval between neoadjuvant chemoradiotherapy and surgery for squamous cell carcinoma of the thoracic esophagus: does delayed surgery have an impact on outcome? Ann Surg 252:788–796PubMedCrossRef
53.
Berger AC, Farma J, Scott WJ et al (2005) Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival. J Clin Oncol 23:4330–4337PubMedCrossRef
54.
Bruecher BLDM, Becker K, Lordick F et al (2006) The clinical impact of histopathological response assessment by residual tumor cell quantification in esophageal squamous cell carcinomas. Cancer 106:2119–2127CrossRef
55.
Langer R, Ott K, Feith M et al (2009) Prognostic significance of histopathological tumor regression after neoadjuvant chemotherapy in esophageal adenocarcinomas. Mod Pathol 22:1555–1563PubMedCrossRef
56.
Rizk NP, Venkatraman E, Bains MS, American Joint Committee on Cancer et al (2007) American Joint Committee on Cancer staging system does not accurately predict survival in patients receiving multimodality therapy for esophageal adenocarcinoma. J Clin Oncol 25:507–512PubMedCrossRef
57.
Swisher SG, Hofstetter W, Wu TT et al (2005) Proposed revision of the esophageal cancer staging system to accommodate pathologic response following preoperative chemoradiation (CRT). Ann Surg 241:810–820PubMedCrossRef
58.
Lightdale CJ, Kulkarni KG (2005) Role of endoscopic ultrasonography in the staging and follow-up of esophageal cancer. J Clin Oncol 23:4483–4490PubMedCrossRef
59.
Jones DR, Parker LA Jr, Detterbeck FC, Egan TM (1999) Inadequacy of computed tomography in assessing patients with esophageal carcinoma after induction chemoradiotherapy. Cancer 85:1026PubMedCrossRef
60.
Swisher SG, Maish M, Erasmus JJ et al (2004) Utility of PET, CT, and EUS to identify pathologic responders in esophageal cancer. Ann Thorac Surg 78:1152–1157PubMedCrossRef
61.
Flamen P, Van Cutsem E, Lerut A et al (2002) Positron emission tomography for assessment of the response to induction radiochemotherapy in locally advanced oesophageal cancer. Ann Oncol 13:361PubMedCrossRef
62.
Downey RJ, Akhurst T, Ilson D et al (2003) Whole body 18FDG-PET and the response of esophageal cancer to induction therapy: results of a prospective trial. J Clin Oncol 21:428PubMedCrossRef
63.
Weber WA, Ott K, Becker K et al (2001) Prediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging. J Clin Oncol 19:3058–3065PubMed
64.
Ott K, Weber WA, Lordick F et al (2006) Metabolic imaging predicts response, survival and recurrence in adenocarcinomas of the esophagogastric junction (AEG) in a prospective trial. J Clin Oncol 24:4692–4698PubMedCrossRef
65.
Lordick F, Ott K, Krause BJ et al (2007) Use of PET to assess early metabolic response and guide treatment of locally advanced adenocarcinoma of the oesophagus and oesophagogastric junction: a feasibility study. Lancet Oncol 8:797–805PubMedCrossRef
66.
Vallböhmer D, Hölscher AH, Dietlein M et al (2009) [18F]-Fluorodeoxyglucose-positron emission tomography for the assessment of histopathologic response and prognosis after completion of neoadjuvant chemoradiation in esophageal cancer. Ann Surg 250:888–894PubMedCrossRef
67.
van Heijl M, Omloo JM, van Berge Henegouwen MI et al (2011) Fluorodeoxyglucose positron emission tomography for evaluating early response during neoadjuvant chemoradiotherapy in patients with potentially curable esophageal cancer. Ann Surg 253:56–63PubMedCrossRef
68.
Blazeby JM, Sanford E, Falk SJ, Alderson D, Donovan JL (2005) Health-related quality of life during neoadjuvant treatment and surgery for localized esophageal carcinoma. Cancer 103:1791–1799PubMedCrossRef
69.
Gutschow CA, Hölscher AH, Leers J et al (2012) Health-related quality of life after Ivor Lewis esophagectomy. Langenbecks Arch Surg 2012 Jun 4. [Epub ahead of print]
70.
Kleinberg L, Gibson MK, Forastiere AA (2007) Chemoradiotherapy for localized esophageal cancer: regimen selection and molecular mechanisms of radiosensitization. Nat Clin Pract Oncol 4:282–294PubMedCrossRef
71.
Minsky B, Pajak TF, Ginsberg RJ et al (2002) INT 0123 (Radiation Therapy Oncology Group 94–05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol 20:1151–1153CrossRef
72.
Herskovic A, Martz K, al-Sarraf M et al (1992) Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med 326:1593–1598PubMedCrossRef
73.
Lordick F, Ebert M, Stein HJ (2006) Current treatment approach to locally advanced esophageal cancer: Is resection mandatory? Future Oncol 2:717–721PubMedCrossRef
74.
Stahl M, Stuschke M, Lehmann N et al (2005) Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 23:2310–2317PubMedCrossRef
75.
Lambrecht M, Haustermans K (2010) Clinical evidence on PET-CT for radiation therapy planning in gastro-intestinal tumors. Radiother Oncol 96:339–346PubMedCrossRef
76.
Lorenzen S, Schuster T, Porschen R et al (2009) Cetuximab plus cisplatin-5-fluorouracil versus cisplatin-5-fluorouracil alone in first-line metastatic squamous cell carcinoma of the esophagus: a randomized phase II study of the Arbeitsgemeinschaft Internistische Onkologie. Ann Oncol 20:1667–1673PubMedCrossRef
77.
Luber B, Deplazes J, Keller G et al (2011) Biomarker analysis of cetuximab plus oxaliplatin/leucovorin/5-fluorouracil in first-line metastatic gastric and oesophago-gastric junction cancer: results from a phase II trial of the Arbeitsgemeinschaft Internistische Onkologie (AIO). BMC Cancer 11:509PubMedCrossRef
78.
Lennerz JK, Kwak EL, Ackerman A et al (2011) MET amplification identifies a small and aggressive subgroup of esophagogastric adenocarcinoma with evidence of responsiveness to crizotinib. J Clin Oncol 229:4803–4810CrossRef
79.
Okines A, Cunningham D, Chau I (2011) Targeting the human EGFR family in esophagogastric cancer. Nat Rev Clin Oncol 8:492–503PubMedCrossRef
80.
Lordick F, Ruers T, Aust DE et al (2008) European Organisation of Research and Treatment of Cancer (EORTC) Gastrointestinal Group: workshop on the role of metabolic imaging in the neoadjuvant treatment of gastrointestinal cancer. Eur J Cancer 44:1807–1819PubMedCrossRef
Metadaten
Titel
Multimodal treatment of esophageal cancer
verfasst von
Florian Lordick
Arnulf H. Hölscher
Karen Haustermans
Christian Wittekind
Publikationsdatum
01.02.2013
Verlag
Springer-Verlag
Erschienen in
Langenbeck's Archives of Surgery / Ausgabe 2/2013
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-012-1001-1

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