Surgery, radiotherapy, and chemotherapy for esophageal cancer

Abstract

Current surgical research addresses the optimal approach to potentially curative resection. Several retrospective studies indicate that the transhiatal procedure is technically safe. It is still unclear, however, whether long-term survival can be improved by using more extensive, transthoracic procedures, including two-regional or three-regional lymph node dissection. Minimally invasive techniques have been described with impressive preliminary results both for preoperative staging and for operative resection of esophageal cancer. For locally irresectable tumors, effective palliation can be achieved with combined intraluminal and external radiotherapy. A slight improvement in local control is achieved by addition of intraluminal radiotherapy to conventional external radiotherapy, but long-term survival is poor. If life expectancy is short, single intraluminal radiotherapy can offer effective relief of dysphagia. As of yet, no data are available comparing this approach with pertubation. Finally, the efficacy of multimodality treatment to improve long-term surgical results has been extensively investigated. After neoadjuvant chemotherapy and/or radiotherapy, pathologically complete remission rates vary widely in several retrospective studies. Sterile surgical specimens seem to be associated with better survival results, although patients with microscopical residual disease may have long-term survival. In conclusion, the data on combined approaches are promising, but more randomized studies are needed to establish their exact role in the treatment of esophageal carcinoma.