Prise en charge thérapeutique du cancer de l'œsophage

Abstract

The prognosis for esophageal cancer remains grim despite recent progress in diagnosis and treatment. Surgery is the standard treatment for stages I and II (only). Neoadjuvant chemotherapy or combined radiation and chemotherapy may be considered for stages IIb and III. Palliative surgery is no longer considered useful. Neoadjuvant or adjuvant radiation treatment does not improve survival. Adjuvant chemotherapy does not improve survival, and the benefits of its neoadjuvant use remain controversial in view of the discordant results. There is strong evidence that a neoadjuvant combination of radiation and chemotherapy improves resection and survival rates compared with surgery alone, but definitive proof is not currently available. Combined radiation and chemotherapy may be considered for locally advanced tumors in responding patients, with curative salvage surgery if the tumor persists. For patients whose tumor is inoperable, a combination of radiation and chemotherapy is the standard treatment.