Using Chemoradiation for Advanced Esophageal Cancer Increases Survival Rates

Thursday, June 26, 2003

SCOTTSDALE, Ariz. – Using Chemoradiation (chemotherapy plus radiation), with or without surgery, has led to a significant increase in the survival rate for esophageal and esophago-gastric cancers over the past ten years according to a presentation given by Leonard L. Gunderson, M.D., radiation oncologist at Mayo Clinic Cancer Center in Scottsdale, at the 39th annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago this month. Gunderson made his presentation along with a thoracic surgeon from M.D. Anderson Cancer Center in Houston and a medical oncologist from Royal Marsden Hospital in London.

Ten years ago it was rare to cure this type of cancer in those for whom surgery was not possible, according to Gunderson. Now, recent statistics show a 42 percent two-year survival rate and a 27 percent five-year survival rate with chemotherapy and radiation, as compared to a 10 percent two-year survival rate and a zero percent five-year survival rate, using radiation alone.

"We've made great advances in the past decade," says Dr. Gunderson. "We used to think that only surgery could cure esophageal cancers, but now we can offer new hope to those with locally advanced esophageal cancer for whom surgery isn't possible. The realization that chemoradiation could save this many lives has been a landmark and practice-changing event."

Approximately 13,000 new cases of esophageal cancer are diagnosed each year in the United States. The esophagus is a tube about 10 to 16 inches in length that is part of the digestive tract. The major function of the esophagus is to carry food from the mouth to the stomach. A valve at the connection between the esophagus and the stomach keeps the contents of the stomach, which are acidic, from backing up and damaging the lining of the esophagus. When the valve is unable to perform its function, the patient has the condition known as acid reflux, which may be a risk factor for developing this type of cancer. Thanks to improved imaging such as endoscopy with ultrasound, it is now possible to better assess the extent of cancer in the esophagus and the gastric junction linking it to the stomach.

The disease site team approach at the Mayo Clinic Cancer Center in Scottsdale, which in the case of esophageal cancers includes gastroenterologists, surgeons, radiation oncologists, medical oncologists, diagnostic radiologists and pathologists, enables each case to be individually evaluated as to the recommended course of treatment.

"We have more tools at our disposal," says Dr. Gunderson. "Our goal now is to make the treatment more tolerable and, when appropriate and safe, more aggressive, so we can increase the odds even more. With improved screening protocols, especially for those who suffer from reflux, I think we will see survival rates rise rather dramatically in the next decade."

Gunderson is past chair of the gastrointestinal committee of the Radiation Therapy Oncology Group, a national study group that includes physicians from the Mayo Clinic Cancer Center in Scottsdale.

Mayo Clinic is a private group practice of medicine dedicated to providing diagnosis and treatment of patient illnesses through a systematic focus on individual patient needs. As a leading academic medical center in the Southwest, Mayo Clinic Scottsdale focuses on providing specialty and surgical care in more than 66 disciplines at its outpatient facility in north Scottsdale and at Mayo Clinic Hospital. The 205-bed hospital is located at 56th Street and Mayo Boulevard (north of Bell Road) in northeast Phoenix, and provides inpatient care to support the medical and surgical specialties of the Clinic, which is located at 134th Street and Shea Boulevard in Scottsdale.

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