Several investigative programs are currently being tried using multidrug chemotherapy , including 5-FU , VP-16 and/or mitomycin-C with radiation therapy .
Intraluminal radiation using a radiation source placed inside the esophagus (brachytherapy) may complement external radiation. The average five-year survival is 5 to 10 percent for radiation treatment alone.
Adjuvant Chemotherapy Chemotherapy alone is of little benefit. But 5-FU + cisplatin chemotherapy, before surgery, will reduce the size of the tumor , allowing a more complete resection (Stages I and II) and may eliminate small metastases. Other chemotherapy programs (5-FU + cisplatin, cisplatin + vinblastine or Bleomycin , 5-FU + mitomycin-C, or cisplatin + 5-FU/leucovorin + VP-16 for neoadjuvant therapy) have shown response to treatment. Studies thus far suggest that carboplatin is less effective than cisplatin and should not be substituted, although it is less toxic.
The role of chemotherapy and radiation therapy is being evaluated. To date, there is significant increased survival from chemotherapy and radiation therapy versus radiation therapy alone. Recent studies of 5-FU + mitomycin-C with radiotherapy have shown an improved survival for Stages I and II disease with almost twice the survival as radiotherapy alone. Tumors of the gastroesophageal junction are treated with combination chemotherapy after surgery, as in stomach cancer ( see "Stomach" ).
