September 7, 2009

Minimally Invasive Treatment Effective for Esophageal Cancer

Researchers at the Mayo Clinic have found that early stage cancers of the esophagus can be treated effectively by organ-sparing endoscopic therapy, thereby avoiding the surgical removal of the esophagus.

Esophageal cancer arising from Barrett's esophagus is increasing faster than any other cancer in the United States. About 10 percent of patients with chronic acid reflux develop the tissue changes characteristic of Barrett's esophagus, which can lead to cancer. The tumor is lethal. Ninety percent of patients die within five years of diagnosis.

In 20 percent of esophageal cancer cases in the U.S., the cancer is detected in the early stages," Ganapathy Prasad, M.D., endocrinologist and lead author on the study was quoted as saying. "Traditionally, esophageal cancer patients undergo a complicated surgery to remove the esophagus. Our team compared surgery to the use of endoscopic therapy, where a scope is inserted in the esophagus and the cancer cells are shaved off. Our results showed the less-invasive therapy was just as effective as surgery for early-stage cancers."

In this study of 178 patients with early-stage esophageal adenocarcinoma, 132 were treated with endoscopic mucosal resection and 46 were treated surgically. The endoscopic mucosal resection patients underwent a procedure where a liquid is injected under the lesion and then an endoscope is used to shave off the lesions. The other patients underwent more traditional removal of the esophagus.

The patients were followed for nine years. Both groups had a comparable overall mortality rate of approximately 20 percent. Cancer recurred in 12 percent of patients treated endoscopically, but doctors were able to treat the recurrence endoscopically.

Dr. Prasad explained that esophagectomy surgery patients are typically in the hospital for a week, and 30 to 50 percent of them experience complications post surgery. For example, esophagectomy patients face lifelong dietary restrictions. Endoscopic treatments, however, are performed in an outpatient setting, and patients can eat full meals within a couple of days.

"If patients do choose to proceed to surgery, they should be advised to seek a high-volume surgical center," Kenneth Wang, M.D., gastroenterologist and senior researcher on the study was quoted as saying. "Research has shown that high-volume hospitals, such as Mayo Clinic, have better survival rates and outcomes for patients."

Dr. Wang says that future research in this area will examine genetic markers to help determine the best course of treatment for esophageal cancer patients. In addition, the Mayo research team hopes to study the use of endoscopic therapy for more advanced esophageal cancers.

SOURCE: Gastroenterology, September 2009