Oesophageal cancer: exploring controversies overview of experts' opinions of Austria, Germany, France, Netherlands and Switzerland.

Paul Martin Putora,J Jan B Van Lanschot,Annelies Schnider,Ate Van Der Gaast,Thomas Ruhstaller,Wolfgang Eisterer,Christophe Mariette,Robert Jäger,Wilfried Budach,Laurent Bedenne,Michael Stahl

doi:10.1186/s13014-015-0418-4

Abstract

BackgroundOesophageal carcinoma is a rare disease with often dismal prognosis. Despite multiple trials addressing specific issues, currently, many questions in management remain unanswered. This work aimed to specifically address areas in the management of oesophageal cancer where high level evidence is not available, performing trials is very demanding and for many questions high-level evidence will not be available in the forseeable future.MethodsTwo experts of each national, oesophageal cancer research group from Austria, France, Germany, the Netherlands and Switzerland were asked to provide statements to controversial issues. After an initial survey, further questions were formulated and answered by all experts. The answers were then discussed and qualitatively analysed for consensus and controversy.ResultsTopics such as indications for PET-CT, reasons for induction chemotherapy, radiotherapy dose, the choice of definitive chemo-radiotherapy versus surgery in squamous cell cancer, the role of radiotherapy in adenocarcinoma and selected surgical issues were identified as topics of interest and discussed.ConclusionAreas of significant controversy exist in the management of oesophageal cancer, mostly due to high-level evidence. This is not expected to change in the upcoming years.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-015-0418-4) contains supplementary material, which is available to authorized users.

Highlights

Oesophageal carcinoma is a relatively rare disease with a still dismal prognosis despite having seen some improvement in management over the last decade mainly reflecting better patient selection, more effective neoadjuvant therapy and improved perioperative management
Published clinical trials often provide insufficient answers for individual patients; too many variables influence the treatment decision such as different histologies implying different clinical biology, the location of the tumour influencing the preferred technique of surgery and radiotherapy or significant co-morbidities
Based on the consensus statement on oesophageal cancer published in 2012 a catalogue of controversial issues and questions was generated

Summary

Introduction

Oesophageal carcinoma is a relatively rare disease with a still dismal prognosis despite having seen some improvement in management over the last decade mainly reflecting better patient selection, more effective neoadjuvant therapy and improved perioperative management. Clinicians must make decisions despite gaps in evidence and many issues will not be solved within clinical trials over the decade. Despite multiple trials addressing specific issues, currently, many questions in management remain unanswered. This work aimed to address areas in the management of oesophageal cancer where high level evidence is not available, performing trials is very demanding and for many questions high-level evidence will not be available in the forseeable future. Operable oesophageal cancer with clinical complete response after neoadjuvant chemoradiation randomised between systematic surgery vs surveillance with selective salvage surgery in case of operable recurrence.

Objectives

Methods

Results

Conclusion