Summary: Esophageal cancer has increasing incidence in Czech Republic with 90% mortality yearly and only 5% long term survivors. Poor results of surgery and high proportion of advanced non-operable cases tend to involvement of new more successful management. Concurrent chemoradiotherapy using doublet of cisplatin plus 5-fluorouracil is standard approach for the treatment of advanced localised stage with results similar to surgical series. Combination of preoperative or adjuvant radiation or chemotherapy with surgery had no survival benefit except for one large randomised study of preoperative chemotherapy from last time. Multimodal treatment with preoperative chemoradiotherapy and consecutive surgery is beneficial based on evidence from several randomised trials and meta-analyses. On the other hand, neoadjuvant chemoradiotherapy increases risk of perioperative mortality. New prognostic and predictive factors are needed for individualisation of treatment in the future. Palliation has influence on quality of life. Last generation of conventional cytotoxic drugs has small treatment improvement, but its role is probably limited and significant advance is awaited from drugs targeting processes as tyrosine kinase signal pathway, apoptosis, cell cycle regulation and angiogenesis.
Complex therapy of esophageal cancer
