Chemotherapy for gastrointestinal malignancy

Cancers of gastrointestinal tract are frequently unresectable at the time of diagnosis and the prognosis for these patients is discouraging. Chemotheapy is often administered in an attempt to prolong life or at least alleviate symptoms. Esophageal squamous cell carcinoma is notoriously refractory to chemotherapy. Gastric carcinoma has higher response rates to combination chemotherapy but over all survival is not greatly prolonged. Advanced pancreatic carcinoma occasionally responds transiently but again median survival is short. Less than 20% of advanced colorectal cancers respond to chemotherapy. Those few patients who do respond usually do live several months longer than nonresponders. The benefits of possible palliation versus the adverse side-effects of these drugs must be weighed on an individual basis. It is still too early to evaluate the efficacy of adjuvant chemotherapy but there may be room for cautious optimism.