September 4, 2009

Less Extensive Treatment Doesn’t Worsen Survival with Early Esophageal Cancer

By Anonymous User

Among patients with esophageal adenocarcinoma that involves only the innermost lining (mucosa) of the esophagus, treatment to remove just the cancer appears to result in similar overall survival as treatment that removes the entire esophagus. These results were published in Gastroenterology.

The esophagus is a muscular tube that food and liquids pass through on their on their way to the stomach. Each year in the United States, more than 16,000 people are diagnosed with cancer of the esophagus and more than 14,000 die of the disease.

The most common types of esophageal cancer are squamous cell carcinoma and adenocarcinoma. The classification is based on the type of cell that becomes cancerous. Esophageal adenocarcinoma—the focus of the current study—develops in the glandular cells of the esophagus.

Treatment of esophageal adenocarcinoma often involves surgical removal of the entire esophagus. For patients with very early-stage cancer, however, it may be possible to preserve the esophagus by removing only the cancer with a procedure known as endoscopic mucosal resection (EMR). EMR may be combined with other procedures such as photodynamic therapy.

To compare outcomes among patients treated with EMR and patients treated with esophagectomy (removal of the esophagus), researchers evaluated the records of 178 patients treated at the Mayo Clinic between 1998 and 2007. All of the patients had mucosal (T1a) esophageal adenocarcinoma. Three-quarters of the patients had been treated with EMR (with or without the addition of photodynamic therapy) and the rest had been treated with esophagectomy.

  • After accounting for age, sex, and several other factors that may affect survival, overall survival was similar between patients treated with esophagectomy and patients treated with EMR.
  • The rate of cancer recurrence was almost 10 times higher in the EMR group than in the esophagectomy group. Recurrences in the EMR group occurred a median of 19 months after initial treatment. All of the recurrences except for one were treated with EMR (one patient opted for esophagectomy). These recurrences did not affect overall survival.

The researchers conclude: “Given these results, endoscopic management appears to be a viable alternative to esophagectomy for patients with mucosal (T1a) esophageal adenocarcinoma.”

Reference: Prasad GA, Wu TT, Wigle DA et al. Endoscopic and surgical treatment of mucosal (T1a) esophageal adenocarcinoma in Barrett’s esophagus. Gastroenterology. 2009;137:815:823.

Tags: Esophageal Cancer, News Tips and Features, Stages I-III Esophageal Cancer

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