Surgery, radiotherapy, and chemotherapy for esophageal carcinoma

Over the last year, several interesting studies have been published on the treatment of esophageal carcinoma. Surprisingly, none of them was a randomized phase III trial. The debate on the necessary extent of a potentially curative surgical resection is ongoing. After initially disappointing results, the innovative technique of minimally invasive surgery draws new attention, but clear advantages for the endoscopic approach are yet to emerge. An updated meta-analysis on the value of preoperative radiotherapy showed negative results. There is a clear tendency toward combined-modality treatment, especially in patients with more advanced disease. Some new chemotherapeutic agents showed promising preliminary results (especially paclitaxel), whereas others were clearly disappointing (eg, gemcitabine, topotecan). Concurrent chemoradiation as primary treatment for proximal (cervical) tumors was remarkably effective.