[Chemoradiotherapy]

In Western countries, chemotherapy or chemoradiotherapy followed by surgery is the standard treatment and definitive chemoradiotherapy is also standard treatment option for localized advanced esophageal cancer. On the other hand, in Japan, only surgery is recognized as standard of care. The position of definitive chemoradiotherapy is unclear in Japan because the evaluation of chemoradiotherapy has not done well so far. Prospective single arm phase II trial of definitive chemoradiotherapy (JCOG 9906) whose primary endpoint is survival was carried out in Japan recently. The survival outcome in JCOG 9906 compared favorably with those of surgery in ordinary institutions. However, the survival in JCOG 9906 was worse than those of surgery in high volume center or cancer center. Late radiation morbidity and the management of non-CR or recurrences after CR cases are major issues in JCOG 9906. In future, new strategy of improved radiotherapy such as 3-D planning, avoiding risk organs and heavy ion therapy or proton therapy, improved medical treatment such as using new anticancer agents or molecular targeting drugs, and the establishment of feasibility in salvage surgery will be required for advances of survival for esophageal cancer.