Review Article

Indian Journal of Surgical Oncology

, Volume 4, Issue 2, pp 96-104

First online:

Multimodality Management of Esophageal Cancer

  • Keduovinuo K. KeditsuAffiliated withDivision of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital
  • , Sabita JiwnaniAffiliated withDivision of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital
  • , George KarimundackalAffiliated withDivision of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital
  • , C. S. PrameshAffiliated withDivision of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital Email author 

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Abstract

Esophageal cancer is a highly lethal and aggressive disease and a major public health problem worldwide. The incidence of esophageal cancer in the western hemisphere has increased by 400 % in the past few decades (Posner et al. 2011). Surgery is the mainstay of definitive management of esophageal cancer; however, the results of surgery alone have been dismal, with survival rates of approximately 15 to 20 % at 5 years (Hingorani et al., Clin Oncol 23:696705, 2011). The last three decades have seen growing interest in various adjuvant and neoadjuvant treatment strategies, with an aim to improve disease control and overall survival. However, due to conflicting and often contradictory results, there was controversy on the ideal treatment paradigm. Recent evidence suggests an improvement in overall survival with neoadjuvant therapy, both chemotherapy and chemoradiotherapy, over surgery. In this review we address various issues concerning multimodality management of locally advanced esophageal cancers: Does neoadjuvant therapy offer a definite benefit over surgery alone? If so, which neoadjuvant strategy? Does the survival benefit outweigh the increased treatment related toxicity/morbidity? Finally, is neoadjuvant treatment the standard of care for locally advanced resectable esophageal cancer?

Keywords

Locally advanced esophageal carcinoma Squamous cell carcinoma Adenocarcinoma Neoadjuvant chemoradiation Neoadjuvant chemotherapy