Management of Cervical Esophageal Carcinoma

Abstract

Surgery and radiotherapy yield equivalent results for patients with carcinoma of the cervical esophagus, with long-term survival of less than one in four patients. The advantages of radiotherapy are lower rates of acute morbidity and mortality compared with surgery, and potential for larynx preservation. The advantage of surgery is that the transposed stomach may function better over the long term than an irradiated esophagus, which tends to become stenotic over time. Patients with resectable cancers who are in good general medical condition may be treated with preoperative irradiation and surgery in an effort to improve the likelihood of local control and obtain a good functional result. Patients with relatively early lesions who are not good surgical candidates can be treated with high-dose radiation therapy. Patients with very advanced local disease and those with distant metastases are treated with palliative irradiation. Concurrent chemotherapy and radiotherapy has been shown to be superior to radiotherapy alone in managing esophageal cancer. Although relatively few patients with cervical esophageal cancer have been treated with this combination, some studies suggest it may be curative for patients with early lesions of the cervical esophagus, without the need for esophagectomy. Adjuvant chemotherapy is usually not used outside of a study setting.