Esophageal Cancer Staging Treatment Model
The treatment of esophageal cancer is still a comprehensive treatment mainly based on surgery. Treatment for esophageal cancer should be proposed after staging by multidisciplinary consultation of surgery, radiotherapy, chemotherapy and other departments. The UICC/AJCC staging (2002) combined with UICC staging (2009) is used below. Guo Zhifeng, Department of Medical Oncology, Chifeng Hospital
1. Stage I (T1N0M0) That is UICC staging (2009) stage IA. Preferred surgical treatment. If poor cardiopulmonary function or unwilling to operate, radical radiotherapy is feasible. Complete resection of stage I esophageal cancer, postoperative adjuvant radiotherapy or chemotherapy is not available. Endoscopic mucosal resection is limited to mucosal cancer, while standard esophageal cancer resection should be performed for submucosal cancer.
2. Stage II (T2-3N0M0, T1-2N1M0) i.e. UICC stage (2009) ⅠB, stage II and part of stage IIIA. Preferred surgical treatment. If poor cardiopulmonary function or unwilling to operate, radical radiotherapy is feasible. For completely resected T2-3N0M0 esophageal squamous carcinoma, postoperative adjuvant radiotherapy or chemotherapy is not available; for completely resected T1-2N1M0 esophageal squamous carcinoma, postoperative adjuvant radiotherapy can improve the 5-year survival rate [27, 28], and postoperative chemotherapy is not recommended [13]. For completely resected T2N0M0 esophageal adenocarcinoma, postoperative adjuvant radiotherapy or chemotherapy is not available; for completely resected T3N0M0 and T1-2N1M0 esophageal adenocarcinoma, postoperative radiotherapy with fluoropyrimidine containing regimen is an option. For patients with R1 and R2, postoperative radiotherapy with fluoropyrimidine-containing regimen is chosen.
3. Stage III (T3N1M0, T4N0-1M0) That is, UICC stage (2009) IIIA, IIIB and some IIIC stages. For patients with T3N1M0 and some T4N0-1M0 (invasion of pericardium, diaphragm and pleura), surgery is still preferred, and neoadjuvant radiotherapy studies can be carried out in hospitals with conditions.
Compared with surgery alone, the value of preoperative chemotherapy is undetermined, and preoperative radiotherapy does not improve survival [32]. However, for esophageal cancer with obvious tumor outgrowth detected by preoperative examination and not easily and completely resected by surgery, the resection rate can be increased by preoperative radiotherapy. For the above stage III patients, postoperative adjuvant radiotherapy may improve the 5-year survival rate. For completely resected esophageal squamous carcinoma, postoperative chemotherapy is not recommended. For completely resected esophageal adenocarcinoma, postoperative adjuvant radiotherapy with fluoropyrimidine containing regimen is an option. For patients with R1 and R2, postoperative radiotherapy with a fluoropyrimidine-containing regimen is chosen.
For inoperable stage III patients, the current standard of care is concurrent radiotherapy.
4. stage IV (any T,any N, M1a, any T,any N, M1b) i.e. UICC staging (2009) partly stage IIIC and stage IV. Palliative care is the main means, for those with better general condition (ECOG score ≤ 2 or Karnofsky score ≥ 60%), additional chemotherapy can be added, and the treatment aims to prolong life and improve quality of life.
Palliative care mainly includes endoscopic treatment (including esophageal dilatation, esophageal stenting and other treatments) and analgesic symptomatic treatment.