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World Journal of Surgery

, Volume 5, Issue 4, pp 489–497 | Cite as

Radiotherapy for esophageal carcinoma

  • James G. Pearson
World Progress in Surgery

Abstract

During the last 30 years, there have been improvements in radiotherapy not matched by improvements in earlier diagnosis. The screening program in the People's Republic of China is an exception. For lower incidence areas, greater patient and physician awareness and the addition of brushings, washings, and cytology to improved barium studies and endoscopy for the earlier investigation of dysphagia may contribute to earlier diagnosis and thus more effective radiotherapy.

There are no experimental data to prove that either surgery or radiotherapy is preferable in the management of the various categories of esophageal cancer; however, close teamwork between the disciplines is fruitful. Neither radio-therapy nor surgery for esophageal cancer is optimal in the hands of the occasional practitioner. In communities where radiotherapy and surgery are both highly developed and closely associated, optimal benefit is likely to be achieved if patients with squamous carcinoma of the middle and upper thirds of the esophagus are treated initially by radiotherapy with surgery held in reserve for local recurrences, and patients with squamous carcinoma of the lower third and all adenocarcinomas are treated surgically unless medically unfit. For the patients treated primarily by surgery, preoperative radiotherapy may help.

Patients with more advanced disease can usually be helped by palliative radiotherapy, with intubation held in reserve until an adequate fluid diet can no longer be swallowed.

Prevention is conceivable and would be unquestionably preferable.

Keywords

Esophageal Cancer Screening Program Esophageal Carcinoma Preoperative Radiotherapy Squamous Carcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Au cours des 30 dernières années, la radiothérapie des cancers oesophagiens s'est améliorée, mais le diagnostic précoce n'a guère fait de progrès. La seule exception est le programme de dépistage en Chine du Nord. Dans les pays et régions où la fréquence du cancer oesophagien est plus faible, le diagnostic précoce (et donc l'efficacité de la radiothérapie) dépend de l'attention des médecins qui doivent, pour toute dysphagie, demander rapidement un examen cytologique après brossage ou lavage de l'oesophage, un examen radiographique de qualité et une endoscopie.

Aucune donnée expérimentale n'a démontré la supériorité de la chirurgie ou de la radiothérapie pour les divers types de cancers oesophagiens. Mais la collaboration étroite interdisciplinaire est utile. Ni la radiothérapie, ni la chirurgie ne constitue le traitement optimal dans les centres qui ne soignent qu'un petit nombre de malades. Dans les unités qui traitent un nombre plus important de patients, où radiothérapeutes et chirurgiens collaborent étroitement et maÎtrisent les techniques, on peut s'attendre à de meilleurs résultats, avec une survie agréable pour le plus grand nombre de malades. Il faut, dans ce but, que les épithélioma des tiers moyen et supérieur de l'oesophage soient traités au début par radiothérapie, la chirurgie étant gardée en réserve pour les récidives locales, et que les épithélioma du tiers inférieurs ainsi que tous les adénocarcinomes soient traités chirurgicalement, sauf si l'état général du malade ne permet pas la chirurgie. Pour les malades traités initialement par chirurgie, la radiothérapie préopératoire peut Être utile.

Lorsque la maladie a atteint un stade avancé, la radiothérapie palliative peut Être utile, l'intubation étant gardée en réserve pour les seuls malades qui ne peuvent plus prendre un régime liquide adéquat. La prévention est concevable et serait certes préférable.

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Copyright information

© Société Internationale de Chirurgie 1981

Authors and Affiliations

  • James G. Pearson
    • 1
  1. 1.Division of Radiation OncologyUniversity of Alberta, Cross Cancer InstituteEdmontonCanada

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