A new study suggests having chemotherapy before surgery to remove a tumor may benefit more patients with esophageal cancer than previously thought.
Tim Underwood, an esophageal surgeon researcher at the University of Southampton in the UK, and colleagues report their findings in the World Journal of Gastroenterology.
But as well as these patients, the new study shows that even those whose tumors do not shrink may also benefit, because the pre-op chemo can reduce the spread of the cancer to the lymph nodes.
The study shows that when spreading to the lymph nodes was reduced, this had a knock-on effect of improving survival and lengthening time to relapse.
Mr. Underwood, an MRC Clinician Scientist, says:
"We still don't know why some patients respond to chemotherapy, and others don't. But this study suggests that more patients than previously thought do benefit from chemotherapy before surgery, which means that having more treatment after their operation might also work for them too."
He and his colleagues also believe having more chemo after surgery would benefit such patients even further.
An aggressive cancer with a very poor prognosis
Esophageal cancer is an aggressive cancer with a very poor prognosis. The cancer forms in the lining of the esophagus or gullet, the pipe that passes food from the throat to the stomach.
The cancer is more common in people who smoke, drink alcohol, are overweight and whose diet is poor in fresh fruits and vegetables.
The National Cancer Institute estimates that 17,990 Americans will be diagnosed with the disease and 15,210 will have died of it in 2013.
In the UK, where around 8,500 new cases are diagnosed every year, esophageal cancer is the ninth most common cancer, and the sixth most common cause of cancer death.
Study investigated 200 patients with adenocarcinoma
There are two types of esophageal cancer, squamous cell carcinoma, which starts in the flat cells in the gullet lining, and adenocarcinoma, which starts in cells that make and release fluids like mucus.
This study, which was funded by Cancer Research UK and the Medical Research Council (MRC), relates to 200 patients with adenocarcinoma who were treated at Southampton General Hospital.
The hospital records showed that of the 136 patients who had chemotherapy before surgery, tumor shrinkage occurred in 36 (26%) of them. So at first it might seem the other 74% did not benefit.
Average time to relapse extended from 1 to over 5 years
However, in the patients who had the pre-op chemo but whose tumors did not respond, there were 30 individuals who showed a reduction in the number of lymph nodes with cancer in them.
And this group showed an increase in the average time to relapse from just under 1 year to over 5.5 years.
Kate Law, director of clinical trials at Cancer Research UK, says the number of cases of esophageal cancer is on the rise, and survival is still poor, adding:
"This study is another piece in the jigsaw in helping us to understand how to tailor treatment to the type of cancer that esophageal patients have."
The researchers now want to find genetic markers that will help them tailor their treatments for patients with esophageal cancer.
Meanwhile, in a Swedish study published recently in the journal Cancer, researchers at the Karolinska Institute found that after surgery, esophageal cancer patients with certain symptoms have poor outcomes and an increased risk of dying of the disease.