Multimodality Therapy of Nonmetastatic Esophageal Cancer

Abstract

Esophageal cancer is a highly aggressive malignancy with an exceedingly poor prognosis. Despite improved surgical techniques over the past decades, which increased the rate of complete tumor resection, improved the perioperative management and reduced the perioperative morbidity and mortality, still less than 10% of patients in the Western World with esophageal cancer will survive more than 5 years. Similar unsatisfactory results are obtained by radiation therapy, despite progress in radiation therapy planning by CT or MRI and application of brachytherapy in addition to teletherapy. This reflects the fact that the disease frequently presents with extensive local regional disease. The resection or the definitive control of the regional tumor with radiation therapy, given as a sole modality, can be difficult. In addition, these patients are at high risk for the development of distant metastases early in the course of the disease. In search of therapeutic gain, combined modality treatments that involve a systemic component seem to be a promising approach. After describing clinically significant anatomic peculiarities of esophageal cancer and discussing pitfalls in the interpretation of published data on the treatment of esophageal cancer, clinical trials will be reviewed critically.