CHEMOTHERAPY IN ESOPHAGEAL CANCER

Esophageal cancer is a virulent malignancy, with the conventional appr oach of surgery or radiation therapy offering patients only a small ch ance for long-term disease-free survival. The frequent early systemic dissemination of disease has prompted an ongoing interest in the study of chemotherapy. A broad range of antitumor agents have been studied which demonstrate moderate antitumor activity. A number of combination chemotherapy regimens, mainly cisplatin-based, have been studied, whi ch have consistently greater antitumor activity in local regional dise ase compared with metastatic disease. The use of preoperative chemothe rapy in the surgical treatment of the disease remains investigational. Results from clinical trials comparing radiation therapy alone with c oncurrent radiation and chemotherapy demonstrate a survival benefit fo r the use of a combination of concurrent chemotherapy and radiation co mpared to radiation therapy alone. However, current studies with conve ntional chemotherapy, radiation and surgery are likely to impart at be st a modest to moderate improvement in the treatment of esophageal car cinoma. The priority in chemotherapy trials, therefore, remains the id entification of new active chemotherapy agents. The search for novel t herapeutic approaches, exploiting advances in understanding of the mol ecular biology of the disease, continues.