Chemotherapy Regimens for Squamous Cell Esophageal Cancer
Treatment Approach Based on Disease Stage
- For early-stage disease, surgery is the treatment of choice, according to the American Society of Clinical Oncology, with chemoradiotherapy being superior to radiotherapy alone for patients unable or unwilling to undergo surgery 4, 6
- Patients with locally advanced squamous cell carcinoma benefit from preoperative chemotherapy or preoperative chemoradiation, which increases rates of complete tumor resection, improves local tumor control, and enhances survival, as recommended by the National Comprehensive Cancer Network 1, 2, 3
- The standard preoperative chemotherapy regimen consists of cisplatin and 5-fluorouracil (5-FU), with a strength of evidence level I, according to the European Society for Medical Oncology 1, 4
- Chemoradiation with close surveillance and early salvage surgery for local tumor progression may be considered as definitive treatment for selected patients with locally advanced disease, particularly in the upper third of the esophagus, with a moderate level of evidence, according to the American College of Radiology 1, 2, 3
- Standard chemoradiotherapy regimen includes cisplatin/5-FU combined with radiation doses of 50.4 Gy, with a high level of evidence, according to the National Cancer Institute 1
Treatment of Metastatic Disease
- Palliative chemotherapy is indicated for selected patients with good performance status, with platin/fluoropyrimidine combinations offering higher efficacy and improved quality of life, according to the European Society for Medical Oncology, with a strength of evidence level II 3, 7, 4
- For Her-2 positive tumors, trastuzumab should be added to cisplatin/fluoropyrimidine combination, with a moderate level of evidence, according to the American Society of Clinical Oncology 3, 7