CURRENT STATUS OF NEW DRUGS AND MULTIDISCIPLINARY APPROACHES IN PATIENTS WITH CARCINOMA OF THE ESOPHAGUS

The incidence of distal esophageal adenocarcinoma and primary proximal gastric carcinoma has increased substantially in the past 15 years, p articularly in North America and in some European countries. Patients with curatively resected cancer consistently have a 10 to 20% 5-year s urvival rate. Radiation therapy alone should not be recommended. Based on the Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group (ECOG) trial in patients with predominantly squamous cell carcin oma, chemoradiotherapy (fluorouracil [5-FU]/cisplatin + 50 Gy of radio therapy) has been shown to be superior in this setting. The most activ e single agents against squamous cell carcinoma are cisplatin, 5-FU, b leomycin, paclitaxel, mitomycin, mitoguazone, vinorelbine, and methotr exate. The most active agents against adenocarcinoma include paclitaxe l and probably mitomycin, mitoguazone, and cisplatin. To my knowledge, there is currently no effective postoperative adjuvant therapy (chemo therapy, radiation therapy, or both). Evidence that preoperative thera py can prolong survival of patients with potentially resectable carcin oma of tile esophagus is lacking. Preoperative chemoradiotherapy can r esult in an approximately 25% complete pathologic response of the prim ary tumor. Preoperative chemoradiotherapy, however, results in substan tial morbidity and even mortality. A recent single-institution, random ized study comparing surgery alone with preoperative 5-FU/cisplatin/vi nblastine and concurrent radiotherapy demonstrated no difference in me dian survival (18 months). Nevertheless, combined-modality therapy hol ds have been formulated and will be investigated in the next few years .