Chemotherapy in esophageal cancer

Esophageal cancer is a virulent malignancy, with the conventional approach of surgery or radiation therapy offering patients only a small chance for long-term disease-free survival. The frequent early systemic dissemination of disease has prompted an ongoing interest in the study of chemotherapy. A broad range of antitumor agents have been studied which demonstrate moderate antitumor activity. A number of combination chemotherapy regimens, mainly cisplatin-based, have been studied, which have consistently greater antitumor activity in local regional disease compared with metastatic disease. The use of preoperative chemotherapy in the surgical treatment of the disease remains investigational. Results from clinical trials comparing radiation therapy alone with concurrent radiation and chemotherapy demonstrate a survival benefit for the use of a combination of concurrent chemotherapy and radiation compared to radiation therapy alone. However, current studies with conventional chemotherapy, radiation and surgery are likely to impart at best a modest to moderate improvement in the treatment of esophageal carcinoma. The priority in chemotherapy trials, therefore, remains the identification of new active chemotherapy agents. The search for novel therapeutic approaches, exploiting advances in understanding of the molecular biology of the disease, continues.