Core treatment options for oesophageal cancer include surgery, antineoplastic agents, and radiotherapy.
A summary of surgical interventions for oesophageal cancer and reported outcomes, principles, and approaches may be found within the NCCN Clinical Practice Guidelines in Oncology - Esophageal and Esophagogastric Junction Cancers.4
While surgery is the standard treatment for the majority of people with resectable oesophageal cancer, neoadjuvant combined chemoradiotherapy may also be used.9, 19, 20 More than 50% of people affected by oesophageal cancer have unresectable tumours or metastases precluding them from curative approaches to treatment.19
Multiple modality treatment approaches incorporating combinations of surgery, radiotherapy and antineoplastic agents have been trialed with improved outcomes reported.9, 16, 19, 20 Such approaches have been developed due to the risk of early systemic spread in oesophageal cancer and overall poor survival rates of people treated with resection alone.16 In the recent CROSS phase III trial, it was concluded that preoperative chemoradiotherapy in individuals with eosophageal or junctional cancer improved locoregional control and was associated with an improved overall survival of 13%.22
Combinations of radiotherapy and antineoplastic agents are used as a curative treatment approach for localised non resectable squamous cell carcinoma, with survival outcomes equal to those for people who have curative surgery.20 The major disadvantage of the combined treatment approach is the significant risk of acute toxicities.21
Radiotherapy and antineoplastic agents as single modalities have some limited use in advanced disease and palliation, yet there has been no associated survival advantage reported with their use. However, it may improve quality of life in people with symptomatic metastatic or unresectable oesophageal cancer through local disease control.14, 23 Palliative radiation is usually well tolerated and can improve symptoms.21
In the future, biological and molecular targeted therapies may be more commonly used to treat oesophageal cancers.24, 25 Many targeted therapies (like sunitinib and bevacizumab24, 25) are currently undergoing testing to assess their benefit and safety. Trastuzumab is a monoclonal antibody against HER2. Addition of trastuzumab to antineoplastic agents as a treatment for advanced HER2+ gastric or oesophagogastric junction cancers has been shown to increase overall survival when compared to chemotherapy alone.26
Cancer Forum. November 2011
• Local therapies and resection in Barrett’s Oesophagus and early oesophagogastric cancer
• Reviewing the role of cytotoxics in oesophagogastric cancer in the refractory, relapsed and advanced settings
• Australian perspective on the role of targeted therapies in gastroesophageal cancer
• Role of radiotherapy in operable oesophageal cancer
Review the NCCN Clinical Practice Guidelines in Oncology - Esophageal and Esophagogastric Junction Cancers4 (a free resource, but you must register and then click 'Remember me' to bypass the login page in future).
- Outline treatment options recommended for Stages I-II oesophageal cancer
- Outline the current evidence based surgical approaches recommended in the management of oesophageal cancer.
Develop a nursing care plan for pre and postoperative care for an individual admitted for an oesophagogastrectomy.