Multimodal treatment of oesophageal carcinoma

Surgery, radiotherapy, and chemotherapy are the main treatment arms for oesophageal carcinoma, and surgical resection is considered as the first choice for curatively resectable tumours. But the prognosis is poor even in the patients who received curative resection, and adjuvant therapy has therefore been investigated, now for over thirty years. Preoperative radiotherapy or chemotherapy have a good effect on the tumour, but prognosis is not improved over surgery alone. Postoperative radiotherapy results in slightly higher survival rates than preoperative radiotherapy. Preoperative chemoradiotherapy has a greater effect on the tumour, but operative mortality is increased, and long time survivors consist of only those who have no cancer cells in the resected specimen. Patients with residual tumour do not survive for a long time. On the other hand, Leichman reported higher survival rates in patients with chemoradiotherapy who did not have surgery compared with those who had received chemoradiotherapy followed by surgery. Surgery thus did not have additive effects in this treatment modality. It is important therefore that prospective, randomized trials comparing chemoradiotherapy with or without surgery are carried out in the near future. The present consensus is that surgical resection is recommended for Stage I, II and parts of Stage III carcinomas, and adjuvant therapy is necessary for those with positive lymph node metastases and/or a positive surgical margin.