Palliative therapy for carcinoma of the esophagus

Despite improvements in medical and surgical care, the prognosis of patients with cancer of the esophagus has remained poor. The majority of patients are candidates for palliative rather than curative therapy. Surgery probably provides the most effective palliation of dysphagia, but it is associated with a high morbidity, and many patients are not candidates for surgery because of underlying medical problems. There are several endoscopic modalities for palliation. The choice of therapy depends on the location of the tumor, the presence or absence of a tracheo-esophageal fistula, and the projected prognosis for the patient. Expandable stents will probably become the treatment of choice for the inoperable patient because of ease of insertion and relative safety. Nevertheless, other endoscopic techniques will be a useful complement prior to stent insertion in order to debulk the tumor. With adequate palliation, attention can be given to treatment that may serve to prolong survival. Future trials on radiation therapy and chemotherapy are necessary so that we can improve survival without sacrificing the patient's quality of life. On the horizon is the administration of chemotherapy through such vehicles as tumor-specific photosensitizing agents, or intratumoral injection of cytotoxic agents.