progressive Barrett's esophagus who have abnormal changes in the cells that indicate cancer might develop (mucosal dysplasia), the esophagus may be removed as a prophylactic measure.
Combined Therapy Surgery is now often used in combination with chemotherapy and radiation therapy . Combined therapy helps prevent the cancer from recurring and slows the spread of metastases. Chemotherapy may be given before surgery to try to decrease the size of the tumor and reduce metastases. Radiotherapy decreases the incidence of local recurrence , and chemotherapy may decrease the incidence of metastatic disease. Using radiochemotherapy before surgery has prolonged the median survival.
Radiation Therapy The earlier the cancer is diagnosed, the better the results of radiation therapy.
Radiation may cure a small number of selected patients, but lesions must be no larger than five centimeters. Generally, radiotherapy is used preoperatively or for relief of symptoms. It is used for palliation if the tumor is larger than 2 in. (5 cm) or if there are distant metastases.
Preoperative radiation can eliminate almost one-third of esophageal cancers but will make only 40 to 67 percent of tumors operable. Very precise treatment planning with use of an x-ray simulator is important for the best results, with CT scans used to plan treatments accurately.
Chemotherapy with 5-fluorouracil (5-FU) infusions and cisplatin will improve the effect of radiation, although adenocarcinoma (Barrett's esophagus) may not be as sensitive to radiotherapy and chemotherapy.
