Combined treatment modalities in esophageal cancer

Esophageal cancer has been conventionally treated with surgery and radiotherapy for many years. The overall results for all cancers are poor because the majority of patients present late for therapy. The advent of increasingly effective chemotherapeutic drugs--used as single agents and in combination--for squamous cancer has added one more modality in the management of esophageal cancer. Previous publications from this institution and in the literature have indicated the palliative efficacy of such chemotherapy management along with surgery and radiotherapy, particularly for advanced disease. The selection of an individual patient likely to respond to chemotherapy, the number of cycles to be given, and their exact timing in relation to radiotherapy and/or surgery still remains a matter of debate. With appropriate endoscopic and imaging techniques, chemotherapy responsive and non-responsive lesions can be generally identified; even radiotherapy responses can be predicted with appropriate evaluation in a majority of cases. This assessment avoids delay in instituting the most appropriate type of treatment for a given patient with esophageal cancer. Cisplatinum-based front-loading (anterior) chemotherapy was used in 75 patients of locally advanced esophageal cancer (greater than 7.5 cm on esophagogram) with a 76% (57/75) overall response rate and 10% (8/75) showing complete responses as judged by esophagogram, endoscopy; and surgical resection in 7. Patients evaluable for 2- and 3-year survivals show a control rate of 35% and 24%, respectively, which is better than hitherto reported for advanced esophageal cancer. Similar reports are now available in the literature, and further studies with combined therapy should be pursued to improve the salvage rates in the usual advanced case of esophageal cancer.