Radiotherapy for esophageal carcinoma

Abstract

During the last 30 years, there have been improvements in radiotherapy not matched by improvements in earlier diagnosis. The screening program in the People's Republic of China is an exception. For lower incidence areas, greater patient and physician awareness and the addition of brushings, washings, and cytology to improved barium studies and endoscopy for the earlier investigation of dysphagia may contribute to earlier diagnosis and thus more effective radiotherapy. There are no experimental data to prove that either surgery or radiotherapy is preferable in the management of the various categories of esophageal cancer; however, close teamwork between the disciplines is fruitful. Neither radio‐therapy nor surgery for esophageal cancer is optimal in the hands of the occasional practitioner. In communities where radiotherapy and surgery are both highly developed and closely associated, optimal benefit is likely to be achieved if patients with squamous carcinoma of the middle and upper thirds of the esophagus are treated initially by radiotherapy with surgery held in reserve for local recurrences, and patients with squamous carcinoma of the lower third and all adenocarcinomas are treated surgically unless medically unfit. For the patients treated primarily by surgery, preoperative radiotherapy may help. Patients with more advanced disease can usually be helped by palliative radiotherapy, with intubation held in reserve until an adequate fluid diet can no longer be swallowed. Prevention is conceivable and would be unquestionably preferable.

Argon beam plasma coagulation in the management of cancers of the esophagus and stomach

“…There are an increasing number of methods of palliating esophagogastric malignancy, including stenting [8], endoluminal ablation with laser [10,17] argon beam [11,15], photodynamic therapy [12], alcohol injection, external beam radiotherapy [13], brachytherapy [9], and chemotherapy [20]. Palliative surgery has its advocates, but ideally it should be limited to gastric resection since the alternative strategies in esophageal carcinoma now provide equivalent relief of symptoms and survival to surgery.…”

Radiation therapy of esophageal carcinoma: Correlation of clinical and radiographic findings

“…However, various studies in the medical literature have shown that these lesions recur locally ~n 50-85% of cases [6,9,18]. Recurrent tumor usually develops between 6 and 12 months following RT, but occasionally as long as 30 months after therapy [11]. Even when the tumor is eradicated locally, these patients frequently die from widespread metastases to the liver, lungs, or mediastinum [9,13,[19][20][21].…”

“…Several authors have reported anecdotal cases in which radiologic studies after completion of RT revealed dramatic regression of tumor with a normal-appearing esophagus or slight residual stricture at the site of the previous lesion [1,6,[10][11][12]. However, it is thought to be extremely difficult to differentiate a benign stricture from residual or recurrent carcinoma on posttreatment barium studies [6,9].…”

“…However, Pearson postulated that when a circumferential cancer involving the muscular layers of the esophageal wall is eradicated by RT, subsequent fibrosis in these muscular layers produces a stricture [11]. Conversely, he thought that a polypoid intraluminal cancer not densely infiltrating the muscular layers of the wall might regress without producing a stricture [11].…”

“…Anecdotal cases have been reported in which esophagrams taken before and after treatment showed regression of the tumor [1,6,[10][11][12][13]. While these lesions may recur, local recurrences have rarely been documented radiographically.…”