Treatments for recurrent esophageal cancer

The following are treatment options for recurrent esophageal cancer, which means that it has come back after it was treated. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

The type of treatment given will depend where the cancer has come back and what type of treatment you had before. Local recurrence means that the cancer has come back in the area around the esophagus. Distant recurrence means that the cancer has come back in other parts of the body.

If you are healthy, you may be offered surgery for a local recurrence of esophageal cancer after endoscopic mucosal resection (EMR) or photodynamic therapy (PDT). The most common surgery used is esophagectomy, which removes the esophagus and nearby lymph nodes. Part of the stomach may be removed as well.

Chemotherapy may be offered for local or distant recurrence of esophageal cancer.

There are no standard treatments for esophageal cancer that does not respond to drugs used in earlier treatments or if it comes back. You may be given the same drugs that you were given before, or different drugs. The following drugs or drug combinations may be used:

• cyclophosphamide (Procytox), doxorubicin and vincristine
• etoposide, leucovorin, fluorouracil
• epirubicin, oxaliplatin and fluorouracil
• epirubicin, oxaliplatin and capecitabine (Xeloda)
• irinotecan, fluorouracil and leucovorin
• docetaxel
• paclitaxel
• irinotecan

Lonsurf (trifluridine/tipiracil) may be used to treat recurrent or metastatic adenocarcinoma tumours at the gastroesophageal (GE) junction. It is used after you have had at least 2 different types of chemotherapy, including oxaliplatin and fluorouracil, along with docetaxel or paclitaxel, or irinotecan.

Chemoradiation is treatment that combines chemotherapy with radiation therapy. Chemotherapy is given during the same time period as radiation therapy. Some types of chemotherapy make radiation therapy more effective.

• If you haven't had chemoradiation therapy as a treatment before, you may be offered it for a local recurrence of esophageal cancer.
• If you have had chemoradiation, it isn't offered for a local recurrence because radiation therapy can't be used again.

Targeted therapy drugs may be used to treat recurrent adenocarcinoma tumours at the gastroesophageal (GE) junction. They are usually combined with chemotherapy.

Trastuzumab is used with chemotherapy drugs to treat HER2-positive tumours. The most common combinations are:

• trastuzumab, cisplatin and fluorouracil
• trastuzumab, cisplatin and capecitabine

Ramucirumab (Cyramza) is a monoclonal antibody that stops cells from using a substance called vascular endothelial growth factor (VEGF), which helps cells form new blood vessels. Without new blood vessels the cells don't get the oxygen and nutrients that they need to grow. Ramucirumab is given in combination with paclitaxel.

External radiation therapy directs radiation at the tumour from a machine outside of the body. It may be offered either alone or as part of chemoradiation.

• It may be used as part of chemoradiation to treat a local recurrence of esophageal cancer, if radiation hasn't been used before.
• It may be used to relieve symptoms, such as pain and difficulty swallowing, from a local or distant recurrence.

Intraluminal brachytherapy may be offered for a local recurrence of esophageal cancer. A radioactive implant is placed into the esophagus near the tumour. The radiation shrinks the tumour so it doesn't block the esophagus, which helps with swallowing and relieves pain.

Endoscopic treatments may be offered for a local recurrence of esophageal cancer. They can help relieve pain or remove a blockage caused by an esophageal tumour. You may be offered the following endoscopic treatments:

• radiofrequency ablation (RFA)
• laser surgery
• photodynamic therapy (PDT)
• esophageal dilation
• esophageal stent
• electrocoagulation or argon plasma coagulation (may not be available in all Canadian treatment centres)
• placement of a feeding tube

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don't work anymore, they're not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can't have or don't want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Talk to your doctor about clinical trials open to people with esophageal cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.