Making sense of multimodality therapy for esophageal cancer

The results of single modality treatment for esophageal cancer have been poor because of a high rate of local recurrence and distant metastasis. This is probably caused by the prevalence of advanced esophageal cancer at the time of diagnosis; only 3% of patients have Stage I disease, and most of them (80%) are Stage III or IV when they become symptomatic. The most frequently involved metastasis sites are lymph nodes (73%), lung (52%), and liver (47%). Neoadjuvant preoperative chemotherapy, radiotherapy, and combined chemoradiation have been added to the treatment of this disease to enhance local control, increase resectability rate, and improve disease-free survival. The results of recent trials are discussed.