Esophageal Carcinoma: Current Controversial Topics

Abstract

Worldwide, esophageal carcinoma is a common gastrointestinal cancer with a high mortality. The incidence of adenocarcinoma of the esophagus is increasing in the western world, but squamous cell carcinoma remains dominant in the underdeveloped parts of the world. Both types of esophageal carcinoma remain equally virulent. Currently, there are no optimal preventative screening programs available and most patients present with advanced or metastatic disease. Although many options are available for improving diagnostic accuracy, a single method has not displayed significant advantages over the others. In addition, selecting a superior treatment regimen has not surfaced. Preferred resection techniques exist, but one method has not illustrated improvements in survival over the others. A lack of improved survival rates with single modality therapies has led to a multi modality approach. However, developments in neoadjuvant and adjuvant therapies have led to mixed conclusions. Collectively, past studies have not shown an optimal neoadjuvant or adjuvant regimen in terms of survival benefit. This review highlights existing staging modalities and treatment regimens for esophageal carcinoma, in an effort to illustrate the controversial nature surrounding its management.

Survival After Neoadjuvant Therapy Compared with Surgery Alone for Resectable Esophageal Cancer in a Population‐based Study

“…The other three trials did not show any significant survival difference between the two treatment strategies. Lack of evidence of improved survival after chemoradiotherapy has also been reported from recent meta‐analyses and review studies 21,24,25,36,37. Thus, our finding of no improvement in overall survival after the use of neoadjuvant therapy in a population‐based setting is in conformity with the previous literature.…”

Detection of survivin-expressing circulating cancer cells in the peripheral blood of patients with esophageal squamous cell carcinoma and its clinical significance

“…Esophageal squamous cell carcinoma (ESCC) is one of the most malignant diseases in the world [1]. Once diagnosed, the prognosis is often poor despite recent advancements made in multidisciplinary treatments.…”

Impact of Hospital Volume on Long-term Survival After Esophageal Cancer Surgery

“…Fourth, postoperative oncological treatment for esophageal cancer was virtually never used in Sweden during the study period because of the absence of any proven effect of such therapy. 1,26 The lack of association between hospital volume and long-term cure deserves a cautious interpretation. More studies are needed to address this issue further.…”