- Published in the flagship journal of the European Society for Medical Oncology, Annals of Oncology, renowned leaders in the field have developed key recommendations for the diagnosis, treatment, and follow-up of oesophageal cancer.
- Providing algorithms for the management of locoregional and advanced/metastatic disease, this present guideline is based on the available scientific data and the authors’ collective opinion.
- Representing a reliable tool to help steer clinical decision making, these consensus recommendations have been compiled by experts in the field including VHIO’s Maria Alsina.
Published in Annals of Oncology as an open access Special Article (1), consensus recommendations compiled by a multidisciplinary panel of leading experts on behalf of the European Society for Medical Oncology’s (ESMO) Guidelines Committee, cover the clinical and pathological diagnosis, staging and risk assessment, treatment, and follow-up of oesophageal cancer patients with locoregional and advanced/metastatic disease.
According to global estimates (2), oesophageal cancer ranks seventh in incidence, with 604,000 new cases diagnosed in 2020. It is the sixth most common cause of cancer-related mortality, with an estimated 544,000 deaths in 2020. Generally diagnosed at late stage, patients have a poor prognosis and despite advancements in targeted and combinatorial treatment approaches, it remains a hard-to-treat tumor type.
Oesophageal cancer (OC) comprises two main subtypes: oesophageal squamous cell carcinoma (OSCC) and oesophageal adenocarcinoma (OAC), and while the former accounts for around 90% of all cases worldwide, the incidence of the latter is on the rise especially in the developed countries, also including oesophagogastric junction (OGJ) adenocarcinoma – a distinct tumor subtype which shares similar molecular characteristics.
“Recent data indicates that cases of oesophageal adenocarcinoma are increasing, especially in individuals under the age of fifty who tend to be diagnosed in more advanced stages. There is an urgent need to detect disease earlier, optimize current treatment strategies, and expand the promise of precision medicine to all oesophageal cancer patients,” says co-author Maria Alsina, a Clinical Investigator of VHIO’s Gastrointestinal and Endocrine Tumors Group led by Teresa Macarulla.
Considering the well-described risk factors of OC including high alcohol consumption, smoking, excess body weight, diet, gastroesophageal reflux disease and Barrett’s oesophagus, among others, the authors highlight that the multidisciplinary assessment and planning prior to treatment must factor in the nutritional status, body weight, and physical fitness of individual patients.
In the following five main chapters, the experts review current classification criteria, treatment approaches and strategies, and briefly review reported results of recent clinical studies. Aimed at steering clinical decision making, the authors provide recommendations for the optimal treatment and multidisciplinary management of early, locally advanced resectable, and advanced/ metastatic OC; each considering the molecular and clinic-pathological features of the distinct subgroups.
Addressing the controversial topic of surveillance after successful therapy for oesophageal and OGJ cancers, the final section is devoted to follow-up, long-term implications, and survivorship. As highlighted in this chapter, for most oesophageal cancer survivors disease relapse occurs within the first two years after local therapy, but potentially treatable recurrence has been reported in patients five years after treatment.
The authors’ recommendations regarding follow-up underpin the importance of close surveillance in optimizing symptom control, providing tailored psychosocial support, as well as possibly detecting disease recurrence earlier in long-term survivors.
This updated ESMO Clinical Practice Guideline has been developed based on the latest available scientific data and the collective, expert opinion of the co-authors. To access this Special Article please click here.
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References:
- Obermannová R, Alsina M, Cervantes A, Leong T, Lordick F, Nilsson M, van Grieken NCT, Vogel A, Smyth EC, on behalf of the ESMO Guidelines Committee, Oesophageal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up† , Annals of Oncology (2022), doi: https://doi.org/10.1016/j.annonc.2022.07.003.
- Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249.
