SURGERY, RADIOTHERAPY, AND CHEMOTHERAPY FOR ESOPHAGEAL CANCER

Current surgical research addresses the optimal approach to potentiall y curative resection. Several retrospective studies indicate that the transhiatal procedure is technically safe. It is still unclear, howeve r, whether long-term survival can be improved by using more extensive, transthoracic procedures, including two-regional or three-regional ly mph node dissection. Minimally invasive techniques have been described with impressive preliminary results both for preoperative staging and for operative resection of esophageal cancer. For locally irresectabl e tumors, effective palliation can be achieved with combined intralumi nal and external radiotherapy. A slight improvement in local control i s achieved by addition of intraluminal radiotherapy to conventional ex ternal radiotherapy, but long-term survival is poor. if life expectanc y is short, single intraluminal radiotherapy can offer effective relie f of dysphagia. As of yet, no data are available comparing this approa ch with pertubation. Finally, the efficacy of multimodality treatment to improve long-term surgical results has been extensively investigate d. After neoadjuvant chemotherapy and/or radiotherapy, pathologically complete remission rates vary widely in several retrospective studies. Sterile surgical specimens seem to be associated with better survival results, although patients with microscopical residual disease may ha ve long-term survival. In conclusion, the data on combined approaches are promising, but more randomized studies are needed to establish the ir exact role in the treatment of esophageal carcinoma.