Abstract
Since the 1980s major advances in surgery, radiotherapy and chemotherapy have established multimodal approaches as curative treatment options for oesophageal cancer. In addition the introduction of functional imaging modalities such as PET-CT created new opportunities for a more adequate patient selection and therapy response assessment.The majority of oesophageal carcinomas are represented by two histologies: squamous cell carcinoma and adenocarcinoma. In recent years an epidemiological shift towards the latter was observed. From a surgical point of view, adenocarcinomas, which are usually located in the distal third of the oesophagus, may be treated with a transhiatal resection, whereas squamous cell carcinomas, which are typically found in the middle and the upper third, require a transthoracic approach. Since overall survival after surgery alone is poor, multimodality approaches have been developed. At least for patients with locally advanced tumors, surgery alone can no longer be advocated as routine treatment. Nowadays, scientific interest is focused on tumor response to induction radiochemotherapy. A neoadjuvant approach includes the early and accurate assessment of clinical response, optimally performed by repeated PET-CT imaging and endoscopic ultrasound, which may permit early adaption of the therapeutic concept. Patients with SCC that show clinical response by PET CT are considered to have a better prognosis, regardless of whether surgery will be performed or not. In non-responding patients salvage surgery improves survival, especially if complete resection is achieved.
Highlights
Since the 1980s major advances in surgery, radiotherapy and chemotherapy have established multimodal approaches as curative treatment options for oesophageal cancer
* Correspondence: maria.wolf@med.uni-muenchen.de 1Klinik und Poliklinik für Strahlentherapie und Radioonkologie, LudwigMaximilians Universität München, Germany Full list of author information is available at the end of the article significantly higher overall survival after resection of AC than Squamous cell carcinoma (SCC) was reported in some studies [5,6,7] whereas a SEER database review of 4752 patients showed no difference [8]
Patients with SCC of the cervical oesophagus, T1 2, with low surgical risk according to Bartels et al [9], can be treated by a limited resection including regional lymphadenectomy and reconstruction using a free jejunal loop with microsurgical vessel anastomoses, whereas T3-4 patients are treated with neoadjuvant radiochemotherapy
Summary
Since the 1980s major advances in surgery, radiotherapy and chemotherapy have established multimodal approaches as curative treatment options for oesophageal cancer. * Correspondence: maria.wolf@med.uni-muenchen.de 1Klinik und Poliklinik für Strahlentherapie und Radioonkologie, LudwigMaximilians Universität München, Germany Full list of author information is available at the end of the article significantly higher overall survival after resection of AC than SCC was reported in some studies [5,6,7] whereas a SEER database review of 4752 patients showed no difference [8]. Patients with SCC of the cervical oesophagus, T1 2, with low surgical risk according to Bartels et al [9], can be treated by a limited resection including regional lymphadenectomy and reconstruction using a free jejunal loop with microsurgical vessel anastomoses, whereas T3-4 patients are treated with neoadjuvant radiochemotherapy.
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