Chemotherapy is a drug, or combination of drugs, that circulates throughout the body to kill cancer cells wherever they may be. Chemotherapy is an important part of treatment for esophageal cancer because in the majority of cases the disease is only detected once it has become advanced and spread to other organs. Chemotherapy drugs can shrink the primary tumor in the esophagus as well as cancerous growths in other areas of the body.
Chemotherapy is used in the treatment of both adenocarcinoma and squamous cell carcinoma of the esophagus. Which drugs your doctors prescribe will depend on the type of cancer you have and other factors identified during your pathology testing.
Doctors called medical oncologists specialize in determining which chemotherapy drugs offer you the best chance to control your cancer. At Memorial Sloan Kettering, medical oncologists work very closely with radiation oncologists, surgical oncologists, and other specialists as part of a disease management team. This approach is particularly important for the treatment of esophageal cancer because studies have shown that combining chemotherapy with other treatments leads to the best outcomes for patients.
Combining Chemotherapy with Other Approaches
In the majority of cases, patients treated for esophageal cancer at Memorial Sloan Kettering receive both chemotherapy and radiation therapy. Several recent studies have shown that such combination therapy, sometimes called chemoradiation, offers the most effective method for curing or controlling the disease.
In many people with squamous cell carcinoma of the esophagus, chemoradiation is sufficient to drive the cancer into remission. Remission means there are no signs of cancer – it does not necessarily mean the patient is cured.
If chemoradiation alone cannot control the cancer, or if you have adenocarcinoma, chemotherapy and radiation therapy may still be given in preparation for surgery to remove the tumor. When used before surgery, this approach is called induction chemotherapy or neoadjuvant chemotherapy.
The combination of chemotherapy, radiation therapy, and surgery is known as trimodality therapy, and support for this approach is growing. In 2010, data from a large clinical trial called the CROSS study showed that chemoradiation followed by surgery has good results for many esophageal cancer patients with relatively small and contained local tumors (1).
Chemotherapy before surgery, also known as neoadjuvant chemotherapy, improves the effectiveness of treatment for esophageal cancer in several ways:
- Systemic drugs given before surgery can reduce the risk that the cancer will recur after the primary tumor has been removed.
- Pretreatment with chemotherapy can shrink the tumor, making it easier for the surgeon to remove the cancer in its entirety.
- When a tumor is blocking the esophagus, chemotherapy can often improve a person’s ability to swallow after just two cycles of treatment.
Neoadjuvant chemotherapy is typically given with radiation therapy for a period of six to ten weeks.
Imaging and Chemotherapy
During your treatment, your doctor may recommend periodic PET scans to observe how your treatment is affecting the tumor. A PET scan can help your doctors see whether the tumor is shrinking. If the tumor does not appear to be responding to treatment, your medical oncologist may recommend changing the medications you are receiving, offering other treatments that may be more effective.
New Medical Approaches
All patients at Memorial Sloan Kettering receive the highest standard of care. At the same time, our doctors are continually working to improve treatment options for people with esophageal cancer. We are conducting a variety of clinical trials to test the effectiveness of new chemotherapy approaches. This means that eligible patients may have access to experimental treatments before they are widely available elsewhere.