SURGERY, RADIOTHERAPY, AND CHEMOTHERAPY FOR ESOPHAGEAL CANCER

During the past year, several excellent reviews have been published on various aspects of esophageal cancer treatment. Pathologic examinatio n of lymph nodes after extensive resections has reconfirmed the early lymphatic spread at a relatively large distance of the primary tumor. Approximately 50% of the patients with intrathoracic tumors invading t he submucosa have positive lymph nodes, half of which are located outs ide the chest. It has been demonstrated that patients with a limited n umber of positive nodes can be cured by extensive surgery at the cost of increased morbidity and mortality, even in experienced hands. Altho ugh the effectiveness of surveillance programs for patients with Barre tt's mucosa is still unclear, both tumor classification and survival a ppear to be more favorable in patients who were referred from surveill ance programs as compared with patients who had not been in such progr ams. The role of video-assisted thoracic surgery seems to be limited t o diagnostic procedures. Prolonged collapse of the lung during video-a ssisted thoracic surgery-esophagectomy induces severe pulmonary compli cations. The role of primary radiotherapy is limited, but favorable re sults have been described in the treatment of early tumors. Primary ch emoradiation can achieve a high frequency of local tumor resolution, a lbeit at the expense of high toxicity. Both after limited and en-bloc resection, locoregional recurrence is most frequently accompanied by d istant metastases, underlining the need for (neo)adjuvant systemic the rapy. Preoperative chemotherapy has resulted in a 45% (partial) respon se rate. Several phase II trials have tested the efficacy of preoperat ive chemoradiotherapy. The disappointing results of two studies indica te that the treatment should be aggressive to reach a substantial impr ovement of survival.