Radiotherapy for esophageal carcinoma.

Abstract

AbstractDuring the last 30 years, there have been improvements in radiotherapy not matched by improvements in earlier diagnosis. The screening program in the People's Republic of China is an exception. For lower incidence areas, greater patient and physician awareness and the addition of brushings, washings, and cytology to improved barium studies and endoscopy for the earlier investigation of dysphagia may contribute to earlier diagnosis and thus more effective radiotherapy.There are no experimental data to prove that either surgery or radiotherapy is preferable in the management of the various categories of esophageal cancer; however, close teamwork between the disciplines is fruitful. Neither radio‐therapy nor surgery for esophageal cancer is optimal in the hands of the occasional practitioner. In communities where radiotherapy and surgery are both highly developed and closely associated, optimal benefit is likely to be achieved if patients with squamous carcinoma of the middle and upper thirds of the esophagus are treated initially by radiotherapy with surgery held in reserve for local recurrences, and patients with squamous carcinoma of the lower third and all adenocarcinomas are treated surgically unless medically unfit. For the patients treated primarily by surgery, preoperative radiotherapy may help.Patients with more advanced disease can usually be helped by palliative radiotherapy, with intubation held in reserve until an adequate fluid diet can no longer be swallowed.Prevention is conceivable and would be unquestionably preferable.