Esophageal Occlusion: Role of Chemoradiation Therapy

  • Caroline E. MurphyEmail author
  • David PadroEmail author


Esophageal occlusion due to esophageal cancer is thankfully a rare occurrence. However, when it does present, it usually means there is advanced disease making surgical resection less effective. As such, there is a role for chemo and radiation therapies to treat the obstructing lesion as well as the systemic and locally advanced disease. In the case of metastatic disease, it can be used for palliation. For earlier or resectable disease, it can be used as neoadjuvant therapy to make a surgical cure more possible. The following chapter will discuss the indications, limitations, and timing for the use of chemo and radiation therapy for esophageal occlusions caused by malignancy.


Esophageal occlusion Esophageal cancer Chemoradiation 


  1. 1.
    Noone AM HN, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA, editors. Esophageal cancer, SEER cancer statistics review, 1975–2015. National Cancer Institute; 2018.Google Scholar
  2. 2.
    Siegel RL, Fedewa SA, Anderson WF, Miller KD, Ma J, Rosenberg PS, et al. Colorectal cancer incidence patterns in the United States, 1974–2013. J Natl Cancer Inst. 2017;109(8)Google Scholar
  3. 3.
    Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Islami F, DeSantis CE, Jemal A. Incidence Trends of Esophageal and Gastric Cancer Subtypes by Race, Ethnicity, and Age in the United States, 1997–2014. Clin Gastroenterol Hepatol. 2019;17(3):429–39.PubMedCrossRefGoogle Scholar
  5. 5.
    Arnold M, Laversanne M, Brown LM, Devesa SS, Bray F. Predicting the future burden of esophageal cancer by histological subtype: international trends in incidence up to 2030. Am J Gastroenterol. 2017;112(8):1247–55.PubMedCrossRefGoogle Scholar
  6. 6.
    Janmaat VT, Steyerberg EW, van der Gaast A, Mathijssen RHJ, Bruno MJ, Peppelenbosch MP, et al. Palliative chemotherapy and targeted therapies for esophageal and gastroesophageal junction cancer. Cochrane Database Syst Rev. 2017;11:CD004063.PubMedGoogle Scholar
  7. 7.
    Valmasoni M, Pierobon ES, Zanchettin G, Briscolini D, Moletta L, Ruol A, et al. Cervical esophageal cancer treatment strategies: a cohort study appraising the debated role of surgery. Ann Surg Oncol. 2018;25(9):2747–55.PubMedCrossRefGoogle Scholar
  8. 8.
    Rice TW, Ishwaran H, Ferguson MK, Blackstone EH, Goldstraw P. Cancer of the esophagus and esophagogastric junction: An eighth edition staging primer. J Thorac Oncol. 2017;12(1):36–42.PubMedCrossRefGoogle Scholar
  9. 9.
    Appelqvist P, Silvo J, Rissanen P. The results of surgery and radiotherapy in the treatment of small carcinomas of the thoracic oesophagus. Ann Clin Res. 1979;11(5):184–8.PubMedGoogle Scholar
  10. 10.
    Earlam R, Cunha-Melo JR. Oesophogeal squamous cell carcinoms: II. A critical view of radiotherapy. Br J Surg. 1980;67(7):457–61.PubMedCrossRefGoogle Scholar
  11. 11.
    Newaishy GA, Read GA, Duncan W, Kerr GR. Results of radical radiotherapy of squamous cell carcinoma of the oesophagus. Clin Radiol. 1982;33(3):347–52.PubMedCrossRefGoogle Scholar
  12. 12.
    Mantravadi RVP, Lad T, Briele H, Liebner ET. Carcinoma of the esophagus: sites of failure. Int J Radiat Oncol Biol Phys. 1982;8(11):1897–901.PubMedCrossRefGoogle Scholar
  13. 13.
    Yang ZY, Gu XZ, Zhao S, Hong ZG, An HL, Hou FX, et al. Long term survival of radiotherapy for esophageal cancer: analysis of 1136 patients surviving for more than 5 years. Int J Radiat Oncol Biol Phys. 1983;9(12):1769–73.PubMedCrossRefGoogle Scholar
  14. 14.
    Cooper JS, Guo MD, Herskovic A, Macdonald JS, Martenson JA Jr, Al-Sarraf M, et al. Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiat Ther Oncol Group JAMA. 1999;281(17):1623–7.Google Scholar
  15. 15.
    Herskovic A, Martz K, al-Sarraf M, Leichman L, Brindle J, Vaitkevicius V, et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 1992;326(24):1593–8.PubMedCrossRefGoogle Scholar
  16. 16.
    De-Ren S. Ten-year follow-up of esophageal cancer treated by radical radiation therapy: analysis of 869 patients. Int J Radiat Oncol Biol Phys. 1989;16(2):329–34.CrossRefGoogle Scholar
  17. 17.
    Okawa T, Kita M, Tanaka M, Ikeda M. Results of radiotherapy for inoperable locally advanced esophageal cancer. Int J Radiat Oncol Biol Phys. 1989;17(1):49–54.PubMedCrossRefGoogle Scholar
  18. 18.
    Sykes AJ, Burt PA, Slevin NJ, Stout R, Marrs JE. Radical radiotherapy for carcinoma of the oesophagus: an effective alternative to surgery. Radiother Oncol. 1998;48(1):15–21.PubMedCrossRefGoogle Scholar
  19. 19.
    Petrovich Z, Langholz B, Formenti S, Luxton G, Astrahan M. Management of carcinoma of the esophagus: the role of radiotherapy. Am J Clin Oncol. 1991;14(1):80–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Shi XH, Yao W, Liu T. Late course accelerated fractionation in radiotherapy of esophageal carcinoma. Radiother Oncol. 1999;51(1):21–6.PubMedCrossRefGoogle Scholar
  21. 21.
    al-Sarraf M, Martz K, Herskovic A, Leichman L, Brindle JS, Vaitkevicius VK, et al. Progress report of combined chemoradiotherapy versus radiotherapy alone in patients with esophageal cancer: an intergroup study. J Clin Oncol. 1997;15(1):277–84.PubMedCrossRefGoogle Scholar
  22. 22.
    Wang JH, Lu XJ, Zhou J, Wang F. A randomized controlled trial of conventional fraction and late course accelerated hyperfraction three-dimensional conformal radiotherapy for esophageal cancer. Cell Biochem Biophys. 2012;62(1):107–12.PubMedCrossRefGoogle Scholar
  23. 23.
    Pasquier D, Mirabel X, Adenis A, Rezvoy N, Hecquet G, Fournier C, et al. External beam radiation therapy followed by high-dose-rate brachytherapy for inoperable superficial esophageal carcinoma. Int J Radiat Oncol Biol Phys. 2006;65(5):1456–61.PubMedCrossRefGoogle Scholar
  24. 24.
    Penniment MG, De Ieso PB, Harvey JA, Stephens S, Au H-J, O’Callaghan CJ, et al. Palliative chemoradiotherapy versus radiotherapy alone for dysphagia in advanced oesophageal cancer: a multicentre randomised controlled trial (TROG 03.01). Lancet Gastroenterol Hepatol. 2018;3(2):114–24.PubMedCrossRefGoogle Scholar
  25. 25.
    Nigro ND, Vaitkevicius VK, Buroker T, Bradley GT, Considine B. Combined therapy for cancer of the anal canal. Dis Colon Rectum. 1981;24(2):73–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Steiger Z, Franklin R, Wilson RF, Leichman L, Asfaw I, Vaishanpayan G, et al. Complete eradication of squamous cell carcinoma of the esophagus with combined chemotherapy and radiotherapy. Am Surg. 1981;47(3):95–8.PubMedGoogle Scholar
  27. 27.
    John MJ, Flam MS, Mowry PA, Podolsky WJ, Xavier AM, Wittlinger PS, et al. Radiotherapy alone and chemoradiation for nonmetastatic. Cancer. 1989;63(12):2397–403.PubMedCrossRefGoogle Scholar
  28. 28.
    Conroy T, Galais MP, Raoul JL, Bouche O, Gourgou-Bourgade S, Douillard JY, et al. Definitive chemoradiotherapy with FOLFOX versus fluorouracil and cisplatin in patients with oesophageal cancer (PRODIGE5/ACCORD17): final results of a randomised, phase 2/3 trial. Lancet Oncol. 2014;15(3):305–14.PubMedCrossRefGoogle Scholar
  29. 29.
    Lorenzen S, Schuster T, Porschen R, Al-Batran SE, Hofheinz R, Thuss-Patience P, et al. Cetuximab plus cisplatin-5-fluorouracil versus cisplatin-5-fluorouracil alone in first-line metastatic squamous cell carcinoma of the esophagus: a randomized phase II study of the Arbeitsgemeinschaft Internistische Onkologie. Ann Oncol. 2009;20(10):1667–73.PubMedCrossRefGoogle Scholar
  30. 30.
    Al-Batran SE, Hartmann JT, Probst S, Schmalenberg H, Hollerbach S, Hofheinz R, et al. Phase III trial in metastatic gastroesophageal adenocarcinoma with fluorouracil, leucovorin plus either oxaliplatin or cisplatin: a study of the Arbeitsgemeinschaft Internistische Onkologie. J Clin Oncol. 2008;26(9):1435–42.PubMedCrossRefGoogle Scholar
  31. 31.
    Bouche O, Raoul JL, Bonnetain F, Giovannini M, Etienne PL, Lledo G, et al. Randomized multicenter phase II trial of a biweekly regimen of fluorouracil and leucovorin (LV5FU2), LV5FU2 plus cisplatin, or LV5FU2 plus irinotecan in patients with previously untreated metastatic gastric cancer: a Federation Francophone de Cancerologie Digestive Group Study--FFCD 9803. J Clin Oncol. 2004;22(21):4319–28.PubMedCrossRefGoogle Scholar
  32. 32.
    Enzinger PC, Burtness BA, Niedzwiecki D, Ye X, Douglas K, Ilson DH, et al. CALGB 80403 (Alliance)/E1206: a randomized phase II study of three chemotherapy regimens plus cetuximab in metastatic esophageal and gastroesophageal junction cancers. J Clin Oncol. 2016;34(23):2736–42.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    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(5):1167–74.PubMedCrossRefGoogle Scholar
  34. 34.
    Meerten EV, van Rij C, Tesselaar ME, Neelis K, Richel D, Hulshof M, et al. Definitive concurrent chemoradiation (CRT) with weekly paclitaxel and carboplatin for patients (pts) with irresectable esophageal cancer: a phase II study. J Clin Oncol. 2010;28(15_suppl):e14508.CrossRefGoogle Scholar
  35. 35.
    Prasad NRV, Karthigeyan M, Vikram K, Parthasarathy R, Reddy KS. Palliative radiotherapy in esophageal cancer. Indian J Surg. 2015;77(1):34–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Shapiro J, van Lanschot JJB, Hulshof M, van Hagen P, van Berge Henegouwen MI, Wijnhoven BPL, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol. 2015;16(9):1090–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Vellayappan BA, Soon YY, Ku GY, Leong CN, Lu JJ, Tey JCS. Chemoradiotherapy versus chemoradiotherapy plus surgery for esophageal cancer. Cochrane Database Syst Rev. 2017;8:CD010511.PubMedGoogle Scholar
  38. 38.
    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(10):2310–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Bedenne L, Michel P, Bouche 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(10):1160–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Ilson DH, Moughan J, Suntharalingam M, Dicker A, Kachnic LA, Konski AA, et al. RTOG 0436: a phase III trial evaluating the addition of cetuximab to paclitaxel, cisplatin, and radiation for patients with esophageal cancer treated without surgery. J Clin Oncol. 2014;32(15_suppl):4007.CrossRefGoogle Scholar
  41. 41.
    Bang YJ, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 2010;376(9742):687–97.CrossRefGoogle Scholar
  42. 42.
    Kato K, Shah M, Enzinger P, Bennouna J, Shen L, Adenis A, et al. P-052A phase 3 study of chemotherapy + pembrolizumab versus chemotherapy + placebo as first-line therapy for patients with advanced esophageal or esophagogastric junction (E/EGJ) cancer: KEYNOTE-590 – Trial in progress. Ann Oncol. 2018;29(suppl_5):mdy151.051.Google Scholar
  43. 43.
    Dai Y, Li C, Xie Y, Liu X, Zhang J, Zhou J, et al. Interventions for dysphagia in oesophageal cancer. Cochrane Database Syst Rev. 2014;10:CD005048.Google Scholar
  44. 44.
    Lettmaier S, Strnad V. Intraluminal brachytherapy in oesophageal cancer: defining its role and introducing the technique. J Contemp Brachytherapy. 2014;6(2):236–41.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    De Palma GD, Sivero L, Galloro G, Siciliano S, Pigna F, Catanzano C. The palliation of dysphagia secondary to esophageal-cardial carcinoma with self-expandable metal prostheses. The authors’ personal experience with 92 patients. Minerva Chir. 1999;54(4):213–8.PubMedGoogle Scholar
  46. 46.
    O’Connor T, Watson R, Lepley D Jr, Weisel W. Esophageal prosthesis for palliative intubation: further evaluation of 378 patients. Arch Surg. 1963;87(2):275–9.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of MedicineTripler Army Medical CenterHonoluluUSA
  2. 2.Division of Radiation OncologyTripler Army Medical CenterHonoluluUSA

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