Combined modality therapy for esophageal cancer

Esophageal cancer remains one of the deadliest gastrointestinal malignancies. Single modality therapy for esophageal cancer usually consists of surgery or radiation therapy. Despite wide ranges in survival rates reported for the two modalities, recent analyses suggest that each offers a 5-year survival of approximately 6%. Surgery plus radiation therapy has been evaluated in a number of studies; results have been equivocal, with response and survival rates similar to those of single modality therapy. Some studies evaluating chemotherapy followed by surgery have resulted in improved partial response rates (17%-57%), with median survival similar to single modality treatment. In two randomized trials, the combination of chemotherapy and surgery was not superior to single modality therapy in terms of response and survival. Because the results of these trials are not in agreement, analysis of results from the recently completed Intergroup study, which compared surgery alone to surgery plus cisplatin/fluorouracil, are eagerly awaited. Studies of radiation plus chemotherapy have shown decreases in both local and distant disease recurrence. Trimodality therapy (surgery plus radiation plus chemotherapy) with a variety of schedules also has been explored. Results suggest that surgery may not be of added benefit to radiation plus chemotherapy; however, a direct comparison of trimodality therapy versus chemotherapy plus radiation has not been performed. Numerous questions remain regarding the most efficacious treatment of nonmetastatic esophageal cancer, and further study is required to identify the ideal treatment.