[Esophageal carcinoma: downstaging or stent?]

Multimodal therapeutic concepts including radio-chemotherapy show: High therapeutic benefit for the (10-40%) responses. -No adequate local and/or systemic response in 35-80% of patients. -Relatively high therapeutic risk (20-70% complication rate). -Hardly acceptable quality of life during downstaging. It is concluded that downstaging should be performed only in controlled trials with differentiated staging and control of the local and distant tumor manifestations. Unclear remains the role of surgery. For palliative intentions endoscopy offers new methods (argon plasma coagulation, metal stents) with high effectivity, low complication rate and high comfort for the patient.