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Annals of Oncology 5:S27-S32, 1994
© 1994 European Society for Medical Oncology

Symposium Article

Esophageal Cancer: Current status and future directions in the treatment of localized esophageal cancer

H. Wilke1, J. R. Siewert2, U. Fink2 and M. Stahl1

1 Department of Internal Medicine (Cancer Research), Essen University Medical School Essen
2 Department of Surgery, Technical University München Klinikum r.d. Isar, München, Germany

Correspondence to: Priv.-Doz. Dr. Hansjochen Wilke, Universitätsklinikum Essen Westdeutsches Tumorzentrum, Innere Universitäts- und Poliklinik (Tumorforschung), Hufelandstraβe 55,45122 Essen Germany

Due to insufficient local tumor control in the majority of esophageal carcinoma (EC) patients and due to distant recurrences, the dismal prognosis of patients with EC has not essentially changed during the past two decades. This holds true despite extended surgical procedures and improved radiation techniques. The 2-year survival rates in stage IIB/III which represent twethirds of the patients with localized EC is still less than 20%. Therefore, clinical efforts in the management of EC focus on combined modality treatment (CTM), usually preoperative chemotherapy (CTx)/chemoradiotherapy (CTx/RTx) or CTx/RTx alone. Up to now, results of CTU in potentially resectable EC have not shown that preoperative CTx or CTx/RTx is superior to surgery alone with respect to resectabitity, local tumor control and overall survival. However, CTx responders who subsequently underwent a complete tumor resection had a markedly im- proved long term survival indicating that the inclusion of CTx in the treatment of EC may improve the prognosis. The benefit of CTx could also be demonstrated in a randomized trial comparing RTx alone versus CTx/RTx with a reduction of local and distant failures and significantly improved survival in the CTM arm. Similar observations were made with CTM in locally advanced disease.

To date, there is sufficient evidence that preoperative treatment of EC may improve prognosis at least of subgroups of patients with this tumor. However, this has to be confirmed in well designed (proper staging including endoscopic ultrasound, etc.) randomized trials. There is also evidence that preoperative CTx/RTx is superior to preoperative CTx alone with respect to local tumor control and induction of pathologically complete remissions (20% versus 5%) and that CTx reduces the risk of distant failures.

esophageal carcinoma, perioperative treatment


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