Cervical Esophageal Cancers: Challenges and Opportunities

  • Michael BucksteinEmail author
  • Jerry Liu
Gastrointestinal Cancers (J Meyer, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Gastrointestinal Cancers


Purpose of the Review

Cervical esophageal cancers (CECs) are a rare subset of esophageal cancers that are distinct in their management and outcomes. This review explores current data on the optimal management of this disease.

Recent Findings

While outcomes for CEC have been suboptimal, several strategies have been proven beneficial in recent years. These include selective surgical resection or salvage surgery, chemoradiation (CRT) vs. radiation (RT) alone, dose escalation, IMRT, and induction chemotherapy.


The optimal management of CEC to achieve the best oncological outcomes and minimize morbidity appears to be definitive chemoradiation with surgery reserved for selective salvage. While the benefit of dose escalated vs. standard dosing for radiation is unclear, most appear to use doses in excess of 50.4 Gy, even in the United States. IMRT might provide a benefit independent of allowing for dose escalation. Induction chemotherapy might allow for “chemoselection”, but the benefit is unclear.


Cervical esophagus cancer Proximal esophagus Squamous cell carcinoma Radiation dose escalation Chemoradiation IMRT 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. Cancer Stat CA Cancer J Clin. 2015;65:87–108.CrossRefGoogle Scholar
  2. 2.
    Davies L, Welch HG. Epidemiology of head and neck cancer in the United States. Otolaryngol - Head Neck Surg. 2006;135:451–7.CrossRefGoogle Scholar
  3. 3.
    Amin MB. AJCC Cancer staging system, 8th edition. Am Jt Commitee Cancer. 2017Google Scholar
  4. 4.
    van Hagen P, Hulshof MCCM, van Lanschot JJB, Steyerberg EW, Henegouwen MI van B, Wijnhoven BPL, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012Google Scholar
  5. 5.
    Yang H, Liu H, Chen Y, Zhu C, Fang W, Yu Z, et al. Neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of the esophagus (NEOCRTEC5010): a phase III multicenter, randomized, open-label clinical trial. J Clin Oncol. 2018Google Scholar
  6. 6.
    Stahl M, Stuschke M, Lehmann N, Meyer HJ, Walz MK, Seeber S, et al. Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol. 2005;23:2310–7.CrossRefGoogle Scholar
  7. 7.
    Bedenne L, Michel P, Bouché O, Milan C, Mariette C, Conroy T, et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol. 2007;25:1160–8.CrossRefGoogle Scholar
  8. 8.
    NCCN. NCCN Clinical practice guidelines in oncology (NCCN guidelines) - esophageal and esophagogastric junction cancers. JNCCN J Natl Compr Cancer Netw. 2017Google Scholar
  9. 9.
    Takebayashi K, Tsubosa Y, Matsuda S, Kawamorita K, Niihara M, Tsushima T, et al. Comparison of curative surgery and definitive chemoradiotherapy as initial treatment for patients with cervical esophageal cancer. Dis Esophagus. 2017Google Scholar
  10. 10.
    Saeki H, Tsutsumi S, Yukaya T, Tajiri H, Tsutsumi R, Nishimura S, et al. Clinicopathological features of cervical esophageal cancer retrospective analysis of 63 consecutive patients who: underwent surgical resection. Ann Surg. 2017;265:130–6.CrossRefGoogle Scholar
  11. 11.
    • Cao CN, Luo JW, Gao L, Xu GZ, Yi JL, Huang XD, et al. Primary radiotherapy compared with primary surgery in cervical esophageal cancer. JAMA Otolaryngol - Head Neck Surg. 2014. A large series of surgical and non-surgical patients are also looking at the benefit of adjuvant therapy. Google Scholar
  12. 12.
    Takebayashi K, Tsubosa Y, Kamijo T, Iida Y, Imai A, Nagaoka M, et al. Comparison of salvage total pharyngolaryngectomy and cervical esophagectomy between hypopharyngeal cancer and cervical esophageal cancer. Ann Surg Oncol. 2017;24:778–84.CrossRefGoogle Scholar
  13. 13.
    Schieman C, Wigle DA, Deschamps C, Nichols FC, Cassivi SD, Shen KR, et al. Salvage resections for recurrent or persistent cancer of the proximal esophagus after chemoradiotherapy. Ann Thorac Surg. 2013;95:459–63.CrossRefGoogle Scholar
  14. 14.
    Mendenhall WM, Sombeck MD, Parsons JT, Kasper ME, Stringer SP, Vogel SB. Management of cervical esophageal carcinoma. Semin Radiat Oncol. 1994;4:179–91.CrossRefGoogle Scholar
  15. 15.
    Nakata Y, Hanai N, Nishikawa D, Suzuki H, Koide Y, Fukuda Y, et al. Comparison between chemoselection and definitive radiotherapy in patients with cervical esophageal squamous cell carcinoma. Int J Clin Oncol. 2017;22:1034–41.CrossRefGoogle Scholar
  16. 16.
    Cao C, Luo J, Gao L, Xu G, Yi J, Huang X, et al. Definitive radiotherapy for cervical esophageal cancer. Head Neck. 2015;37:151–5.CrossRefGoogle Scholar
  17. 17.
    Gkika E, Gauler T, Eberhardt W, Stahl M, Stuschke M, Pöttgen C. Long-term results of definitive radiochemotherapy in locally advanced cancers of the cervical esophagus. Dis Esophagus. 2014;27:678–84.CrossRefGoogle Scholar
  18. 18.
    Zhang P, Xi M, Zhao L, Qiu B, Liu H, Hu YH, et al. Clinical efficacy and failure pattern in patients with cervical esophageal cancer treated with definitive chemoradiother apy. Radiother Oncol. 2015;116:257–61.CrossRefGoogle Scholar
  19. 19.
    Li HX, Liu J, Cheng Y, Liu MN, Fang WT, Lv CX. Concurrent chemoradiotherapy for cervical esophageal squamous cell carcinoma: treatment results from a prospective observational study. Dis esophagus Off J Int Soc Dis Esophagus. 2018Google Scholar
  20. 20.
    •• Zenda S, Kojima T, Kato K, Izumi S, Ozawa T, Kiyota N, et al. Multicenter phase 2 study of cisplatin and 5-fluorouracil with concurrent radiation therapy as an organ preservation approach in patients with squamous cell carcinoma of the cervical esophagus. Int J Radiat Oncol Biol Phys. 2016. The only prospective series dedicated to chemoradiation for cervical esophageal cancers with clear data on outcomes and toxicity. Google Scholar
  21. 21.
    Kim TH, Lee IJ, Ji-Hyun K, Lee CG, Lee YC, Kim JW. High-dose versus standard-dose radiation therapy for cervical esophageal cancer: retrospective single-institution study. Head Neck. 2019;41:146–53.PubMedGoogle Scholar
  22. 22.
    • McDowell LJ, Huang SH, Xu W, Che J, Wong RKS, Brierley J, et al. Effect of intensity modulated radiation therapy with concurrent chemotherapy on survival for patients with cervical esophageal carcinoma. Int J Radiat Oncol Biol Phys. 2017. A well-done series looking at the potential benefit of IMRT over other radiation techniques. Google Scholar
  23. 23.
    Ito M, Kodaira T, Tachibana H, Tomita N, Makita C, Koide Y, et al. Clinical results of definitive chemoradiotherapy for cervical esophageal cancer: comparison of failure pattern and toxicities between intensity-modulated radiotherapy and 3-dimensional conformal radiotherapy. Head Neck. 2017;39:2406–15.CrossRefGoogle Scholar
  24. 24.
    Minsky BD, Pajak TF, Ginsberg RJ, Pisansky TM, Martenson J, Komaki R, et al. INT 0123 (radiation therapy oncology group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol. 2002;20:1167–74.CrossRefGoogle Scholar
  25. 25.
    Herrmann E, Mertineit N, De Bari B, Hoeng L, Caparotti F, Leiser D, et al. Outcome of proximal esophageal cancer after definitive combined chemo-radiation: a Swiss multicenter retrospective study. Radiat Oncol. 2017;12:97.CrossRefGoogle Scholar
  26. 26.
    Ludmir EB, Palta M, Zhang X, Wu Y, Willett CG, Czito BG. Incidence and prognostic impact of high-risk HPV tumor infection in cervical esophageal carcinoma. J Gastrointest Oncol. 2014Google Scholar
  27. 27.
    • De B, Rhome R, Doucette J, Buckstein M. Dose escalation of definitive radiation is not associated with improved survival for cervical esophageal cancer: a National Cancer Data Base (NCDB) analysis. Dis esophagus Off J Int Soc Dis Esophagus. 2017;30. A very large series on cervical esophageal cancer looking at the effects of dose escalation on overall survival. Google Scholar
  28. 28.
    Stuschke M, Stahl M, Wilke H, Walz M, Oldenburg A, Stüben G, et al. Induction chemotherapy followed by concurrent chemotherapy and high-dose radiotherapy for locally advanced squamous cell carcinoma of the upper-thoracic and midthoracic esophagus. Am J Clin Oncol Cancer Clin Trials. 2000;23:233–8.CrossRefGoogle Scholar
  29. 29.
    Goodman KA, Niedzwiecki D, Hall N, Bekaii-Saab TS, Ye X, Meyers MO, et al. Initial results of CALGB 80803 (Alliance): a randomized phase II trial of PET scan-directed combined modality therapy for esophageal cancer. J Clin Oncol. 2017;35:1.CrossRefGoogle Scholar
  30. 30.
    Posner MR, Hershock DM, Blajman CR, Mickiewicz E, Winquist E, Gorbounova V, et al. Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med. 2007;357:1705–15.CrossRefGoogle Scholar
  31. 31.
    Haddad R, O’Neill A, Rabinowits G, Tishler R, Khuri F, Adkins D, et al. Induction chemotherapy followed by concurrent chemoradiotherapy (sequential chemoradiotherapy) versus concurrent chemoradiotherapy alone in locally advanced head and neck cancer (PARADIGM): a randomised phase 3 trial. Lancet Oncol [Internet]. Elsevier; 2013 [cited 2019 Mar 8];14:257–64. Available from: Accessed February 25, 2019.
  32. 32.
    Cohen EEW, Karrison TG, Kocherginsky M, Mueller J, Egan R, Huang CH, et al. Phase III randomized trial of induction chemotherapy in patients with N2 or N3 locally advanced head and neck cancer. J Clin Oncol. American Society of Clinical Oncology. 2014;32:2735–43. Scholar
  33. 33.
    Li M, Liu Y, Xu L, Huang Y, Li W, Yu J, et al. Computed tomography–based distribution of involved lymph nodes in patients with upper esophageal cancer. Curr Oncol. 2015;22:178–e182.CrossRefGoogle Scholar
  34. 34.
    Liu M, Zhao K, Chen Y, Jiang GL. Evaluation of the value of ENI in radiotherapy for cervical and upper thoracic esophageal cancer: a retrospective analysis. Radiat Oncol. 2014;9:232.CrossRefGoogle Scholar
  35. 35.
    Chen Z, Ren Y, Du XL, Yang J, Shen Y, Li S, et al. Incidence and survival differences in esophageal cancer among ethnic groups in the United States. Oncotarget. 2017Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiation OncologyIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Department of Radiation OncologyMount Sinai Beth IsraelNew YorkUSA

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