MULTIMODAL TREATMENT FOR SQUAMOUS-CELL ESOPHAGEAL CANCER

Preoperative chemotherapy (CTx) and combination radiochemotherapy (RTx /CTx) in patients with squamous cell esophageal carcinoma has recently received increasing attention. Although several prospective randomize d trials could not show any benefit of neoadjuvant therapy in patients with potentially resectable tumors, preoperative CTx and combination RTx/CTx appear to increase the resection rate, the rate of complete tu mor resection, and survival time in patients with locally advanced tum ors. Most available studies show that a survival benefit from multimod al therapy can be expected primarily in patients who have a complete h istopathologic response to preoperative treatment (i.e., no viable tum or in the resected specimen). Preoperative RTx/CTx increases the respo nse rate and improves local tumor control compared to preoperative CTx alone, but it is associated with substantial perioperative mortality and morbidity. Distant tumor recurrences are insufficiently controlled with current combined modality protocols. These data indicate that ne oadjuvant therapy must be considered investigational in patients with potentially resectable esophageal carcinoma but may soon become standa rd in patients with locally advanced tumors. Research must focus on mo dalities that allow pretherapeutic identification of those patients wh o will respond to neoadjuvant therapy. Furthermore, more effective and less toxic preoperative therapy regimens are required to increase the response rates and combat systemic recurrences. Finally, randomized p rospective studies are essential to assess the role, extent, and timin g of surgical resection for the combined modality approach to patients with squamous cell esophageal carcinoma.