Toxicity of chemotherapy for esophageal carcinoma

The prognosis of patients with clinically locoregional esophageal cancer is poor due to systemic recurrence of disease and a significant rate of local recurrence. Therefore, systemic chemotherapy in combination with radiation therapy and surgery has been evaluated extensively. Recent trials suggest a trend toward improved survival with the use of combined modality therapy compared with surgery alone. Toxicity in these trials, particularly when preoperative chemoradiotherapy is given, often is substantial and has tempered enthusiasm for the routine use of this treatment approach. The focus of recent studies is the identification of more active and better-tolerated systemic chemotherapy; the drug paclitaxel in particular is a promising new agent. In the nonsurgical, radiotherapy-based treatment of esophageal cancer, a combination of chemotherapy and radiation is superior to radiotherapy alone and now is standard treatment.