[Combined treatment of esophageal cancer: a review]

Abstract

While still relatively uncommon in many countries, esophageal cancer is fatal in the vast majority of cases. In the USA, estimated 13,100 of new cases were diagnosed in 2002. In Lithuania, 163 new cases were diagnosed in 2001. Evidence for an association between environment, diet and esophageal cancer comes from the profound differences in incidence observed in different parts of the world. While the overall outlook for patients diagnosed with esophageal cancer has improved in the last 30 years, most patients are still present with advanced disease and their survival remains poor. Commonly etiology and risk factors of esophageal cancer are: cigarettes and alcohol, diet and other genetics factors. Only in 50% of patients with esophageal cancer clinically localized disease is present. National Comprehensice Cancer Network (NCCN) guidelines state that patients with clinically localized disease may be treated with resection or chemotherapy plus radiation. The overall survival rates for either surgery alone or combined chemotherapy and radiation appear equivalent. Chemoradiation as primary management of localized esophageal cancer has been shown to be superior in radiation alone. A series of randomized trials have demonstrated that adjuvant postoperative chemoradiation does not offer a survival advantage to patients with esophageal cancer. The superiority of preoperative chemoradiation over surgery alone in esophageal cancer has been demonstrated in a prospective trials. Recently published phase I and II studies have demonstrated moderate response rates to taxanes in esophageal cancer. Taxanes and irinotecan in combinations with platinum compounds and fluoropyrimidines are being tested in regimes with radiation.