Downstaging, Neoadjuvant Therapy Improve Outcomes

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Cancer of the esophagus has often spread into the wall of the esophagus or into adjacent lymph nodes by the time it is diagnosed. "We typically see patients with mid to late stage cancers with cure rates of about 20%," explained Barbara Burtness, M.D., Yale medical oncologist. Burtness and Yale’s esophageal cancer team are focusing clinical trials to downstage esophageal cancers through neoadjuvent, or preoperative, chemotherapy and radiotherapy. "If we can shrink the tumor and reduce the likelihood of positive lymph nodes and involvement at the surgical margins, we can improve survival rates," she said.

"The most effective treatment appears to be combining radiation and chemotherapy before surgery, rather than surgery alone," she said. "In our recent trial, surgery was followed with a taxol-based regimen that the patient was not ‘resistant’ to." While the median survival has not been reached, 62% of patients were alive at two years. The results are better than previously reported for stage II through IVa cancers treated with surgery alone or with chemoradiation followed by surgery. "Improved survival appears to be tied to the post-surgical chemotherapy fighting cancer that is "lower stage" with fewer positive lymph nodes," Burtness said.

New Trial Underway

A second trial is underway with chemotherapy given in a low-dose, weekly fashion that is called "metronomic chemotherapy." The regimen also includes a gene therapy treatment designed to increase the effectiveness of the radiation.

For more information contact Dr. Barbara Burtness, M.D., at 203-737-5064 or barbara.burtness@yale.edu.

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