CANCER OF THE ESOPHAGUS

Oesophageal cancer is the fourth most common tumour in developing coun tries, comprising mainly squamous cell tumours, although the incidence of adenocarcinoma has increased enormously over the last decades. Sur gical resection has long been acknowledged as the mainstay of treatmen t, and developments in surgical technique are reviewed. The roles of r adiotherapy and chemotherapy in the management of oesophageal cancer r emain unclear, especially as the majority of studies to date have been uncontrolled trials. We present an analysis of 601 patients who under went resection for carcinoma of the oesophagus between 1970 and 1994 i n the Department of Clinical Surgery, St James's Hospital, Dublin. The analysis shows clearly that, while perioperative mortality continues to improve, conventional surgery offers little prospect of cure in the majority of cases. We have therefore embarked upon a prospective cont rolled trial of neoadjuvant chemoradiotherapy followed by surgery vers us surgery alone in patients with adenocarcinoma or squamous cell tumo urs of the oesophagus. Preliminary results indicate that multi-modalit y treatment may have a valuable role to play in the treatment of carci noma of the oesophagus.