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55

NCCN Guidelines for Patients

®

Esophageal Cancer, Version 1.2016

Guide 8

lists treatment options following

chemoradiation. Options are based on the intent of

your treatment and how well the tumor responds to

chemoradiation.

How the tumor responds to chemoradiation will be

assessed by a CT scan with contrast of your chest

and abdomen or PET with or without CT. CT of

your chest and abdomen is not needed if you have

a PET/CT. PET/CT or PET should occur at least 5

weeks after initial treatment has ended.

Sometimes an upper GI endoscopy with biopsy is

needed. It is used to assess how chemoradiation

is working, especially if surgery may not be needed

or possible. If you want to avoid surgery, it may be

best to wait 6 or more weeks to have an upper GI

endoscopy. If you will have surgery, an upper GI

endoscopy with biopsy is optional.

Options after preoperative chemoradiation

If there are no signs of cancer, an esophagectomy

and follow-up care are options. If cancer remains

in or near the esophagus, an esophagectomy is

the preferred treatment but supportive care is also

an option. Supportive care is also advised if the

cancer has spread to distant sites. Supportive care

is addressed later in this chapter in the section

Advanced cancer

.

Options after definitive chemoradiation

If there are no signs of cancer, follow-up care is

advised. If cancer remains in or near the esophagus,

an esophagectomy and supportive care are options.

Supportive care is also advised if the cancer has

spread to distant sites. Supportive care is addressed

later in this chapter in the section

Advanced cancer.

Guide 9

lists treatment options following an

esophagectomy. The results of surgery are used to

decide if more treatment is needed. Surgery results

include: 1) no cancer is in the surgical margin;

2) cancer is in the surgical margin; 3) not all the

cancer that the surgeon could see in or near the

esophagus was removed; and 4) cancer was found in

distant sites (M1 score).

Your surgeon may have been able to remove all the

cancer and a cancer-free surgical margin. In this

case, no more treatment is needed. The next step is

to start follow-up care.

If cancer is found in the surgical margin,

chemoradiation is advised. Chemoradiation will

treat any cancer that may remain in your body. The

recommended chemotherapy for chemoradiation

is fluoropyrimidine (infusional fluorouracil or

capecitabine) before and after fluoropyrimidine-based

chemoradiation. Chemoradiation can only be received

if you haven’t had it before. Observation is another

option if you have had chemoradiation. Observation is

a period of testing to check for any cancer growth.

After surgery, there still may be cancer near to or far

from your esophagus. In this case, chemoradiation

and supportive care are options. The recommended

chemotherapy for chemoradiation is fluoropyrimidine

(infusional fluorouracil or capecitabine) before

and after fluoropyrimidine-based chemoradiation.

Supportive care is addressed later in this chapter in

the section

Advanced cancer.

5

Treatment guide: Squamous cell carcinoma Invasive cancer