Secondary esophageal tumors: Treatment and outcome in 115 consecutive patients

115 of 1974 patients with esophageal cancer observed between 1980 and 1990 presented with secondary esophageal malignancy. Secondary esophageal involvement was due to primary lung cancer in 43 patients, recurrent lung carcinoma in 15, recurrent laryngeal cancer in 31, neoplastic mediastinitis due to breast cancer in 11, thyroid cancer in 6, and miscellaneous malignancies in 9. The tumor involved the cervical, upper, middle and lower thoracic esophagus in 37, 15, 50 and 13 patients, respectively. Surgical resection was possible in 12 patients with recurrent laryngeal cancer, and in 3 with thyroid cancer. The other treatments were palliative: push intubation in 43 cases, feeding gastrostomy in 14, pull intubation in 7, sub-sternal gastric by-pass in 4, endoscopic dilatation in 3, naso-gastric feeding tube in 3, Nd:Yag laser therapy in 2 and photo dynamic therapy in 1. Radiotherapy, chemotherapy and radio-chemotherapy were carried out along with the treatments in 6, 17 and 7 patients, respectively. The 2-year actuarial survival rates were as follows: 3% for lung cancer, 0% for recurrent lung cancer, 22% for recurrent laryngeal cancer, 9% for breast cancer, 0% for thyroid cancer, 16% for others. In conclusion, secondary esophageal malignancies are relatively rare. Surgical resection can be performed only in selected patients with the cervical esophagus involved by laryngeal or thyroid cancer. In other cases, endoscopic palliation of dysphagia and/or radiation and chemotherapy are recommended.