Treatments post triple threat to esophageal cancer
The cancer is notoriously difficult to cure. But those facing esophageal cancer may soon get some help from a combination of powerful technologies. City of Hope researchers recently showed that uniting the advanced radiation system called TomoTherapy together with robotic surgery and potent chemotherapy may improve survival.
“Our initial results are encouraging,” said Yi-Jen Chen, M.D., clinical assistant professor of radiation oncology and a study author. “We plan to continue this treatment approach and refine it to benefit our patients, and perhaps influence care at other centers.”
photo: PAULA MYERSRadiation physicist An Liu demonstrates TomoTherapy to radiation oncologists from Spain on a City of Hope tour linked to the American Society for Therapeutic Radiation Oncology Annual Meeting.
The research team studied 20 patients treated at City of Hope from 2005 to 2007 for locally advanced esophageal cancer — cancer that’s spread to nearby tissue or lymph nodes. Most patients like these would likely die of cancer within a year without any treatment, physicians said. With treatment, though, outcomes were much different.
All of the patients received chemotherapy and radiation therapy; some also were able to undergo surgery after radiation.
Radiation oncologists used City of Hope’s TomoTherapy Hi-Art System. Through TomoTherapy, radiation oncologists not only can administer therapy, but they also can create images through computed tomography to make sure they’re precisely targeting a tumor and avoiding healthy tissue as much as possible.
That means physicians can administer radiation doses more evenly within esophagus tumors, while also sparing the nearby vulnerable structures of the neck, chest and upper abdomen.
After chemotherapy and radiation, 10 of the 20 patients were able to undergo surgery through City of Hope’s robotic methods, which involve removing the esophagus and potentially cancer-harboring lymph nodes nearby. The rest of the patients didn’t undergo surgery, either because they chose not to or because surgery was deemed too risky for them.
A year later, all 10 patients treated through chemotherapy, radiation and surgery remained alive, compared to 58 percent of patients treated with chemotherapy and radiation. After two years, about 83 percent of the patients treated with chemotherapy, radiation and surgery remained alive.
“We’re excited to be able to bring our disciplines together to fi nd solutions for this form of cancer,” said Kemp Kernstine, M.D., Ph.D., director of the Lung Cancer and Thoracic Oncology Program and one of the study’s co-authors.
Improvements in care are desperately needed, as one particular form of esophagus cancer — adenocarcinoma — is becoming more common. It’s usually diagnosed at a late stage, making successful treatment tough.
“Adenocarcinoma is certainly on the rise, related to increased incidence of Barrett’s esophagus in the Western world,” explained Dean Lim, M.D., City of Hope medical oncologist and study co-author. In Barrett’s esophagus, the esophagus changes so that some of its lining becomes like tissue normally found in the intestine.
Barrett’s esophagus usually causes no symptoms itself, but it can sometimes lead to esophageal cancer. It’s associated with the common condition called gastroesophageal refl ux disease, or GERD. The risk of adenocarcinoma is 30 to 125 times higher in people who have Barrett’s esophagus than it is in others, according to the National Institute of Diabetes and Digestive and Kidney Disorders.
“This is especially being seen with the increasing incidence of GERD, which is seen mostly in obese males,” Lim said.
About 15,560 people were diagnosed with esophageal cancer in 2007, according to the American Cancer Society. The disease is three to four times as common among men than among women.