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- Fri Feb 22, 2008 3:31 pm
My father, age 69, was diagnosed with Stage 1 esophageal cancer. He has elected only radiation therapy, although CT/RT was recommended (he is not a candidate for surgery). I have read in various publications that RT is considered palliative and that 3- and 5-year survival rates are 0% for patients receiving only RT. Is this accurate even for Stage 1? I appreciate your time and look forward to your response.
| Dr. Tamer Fouad
- Sat Feb 23, 2008 6:36 am
I am sorry to hear about your father's diagnosis. Cancer usually strikes at old age and this greatly limits the options for adequate therapy, even when such therapy is available.
As you have mentioned, combined modality therapy with chemotherapy, radiotherapy and surgery is the preferred method to treat many early cases. However, as in the case of your father, they may not be optimal for all patients. That said, however, the role of radiation therapy alone in early stage esophageal cancer is not obsolete. As regards survival data, I have done my best to include references below from the literature. You fill find a survival range of approximately 30% to 20% at 3 years and 5 years respectively for early stages of esophageal cancer. Please also note that most of these landmark studies were done before the era of combined modality therapy and that, on a more optimistic note, modern methods of RT dosing, and delivery offer better therapeutic results.
Again, although stage is the most important prognostic factor for esophageal cancer, there are still many other prognostic factors that are not yet fully understood. Those include, the pathology (squamous cell carcinoma vs adenocarcinoma), location (cervical, thoracic or gastroesophageal) as well as less well understood molecular parameters. All these factors can influence prognosis as well as the incidence and pattern of recurrence (local recurrence vs metastasis).
In the preliminary results of a Chinese study presented at the American Society of Clinical Oncology (ASCO) 2006 meeting the use of modern RT alone (three-dimensional conformal RT [3D-CRT], intensity modulated RT [IMRT]) was associated with a 3 and 5 year survival of 61 and 37 percent, respectively. This was not significantly different from those in the same trial that received surgery alone (56 and 35 percent, respectively). These are promising early results and although they have not yet been advocated for general application (e.g. these patients had squamous cell carcinoma of the esophagus) they certainly emphasize the value of RT in the treatment of esophageal cancers.
I have collected for you the most important references on the subject to the best of my knowledge and I urge you to discuss this further with his doctor:
Earlam R; Cunha-Melo JR. Oesophogeal squamous cell carcinomas: II. A critical view of radiotherapy. Br J Surg 1980 Jul;67(7):457-61.
Choi, NC. The role of radiation therapy in the management of malignant neoplasms of the esophagus. In: Current Therapy in Cardiothoracic Surgery, Grillo, HC, Austen, WG, Wilkins, EW Jr (Eds), BC Decker Inc., Toronto 1989. p.197.
Sykes AJ; Burt PA; Slevin NJ; Stout R; Marrs JE. Radical radiotherapy for carcinoma of the oesophagus: an effective alternative to surgery. Radiother Oncol 1998 Jul;48(1):15-21.
Choi, NC. Carcinoma of the esophagus. In: Clinical Radiation Oncology: Indications, Techniques, Results. Wang, CC (Ed), Wiley-Liss, New York 2000. p.333.
Shioyama Y; Nakamura K; Sasaki T; Ooga S; Urashima Y; Kimura M; Uehara S; Terashima H; Honda H. Clinical results of radiation therapy for stage I esophageal cancer: a single institutional experience. Am J Clin Oncol 2005 Feb;28(1):75-80.
Yu, J, Ren, R, Sun, X, et al. A randomized clinical study of surgery versus radiotherapy in the treatment of resectable esophageal cancer (abstract). J Clin Oncol 2006; 24:181s. (Abstract available online at http://www.asco.org/portal/site/ASCO/me ... 730ad1RCRD, accessed October 6, 2006).