Multimodality therapy of local regional esophageal cancer.
Recent trials regarding the use of multimodality therapy for patients with cancers of the esophagus and gastroesophageal junction have not conclusively shown benefit. Regimens containing cisplatin and fluorouracil administered preoperatively appear to be tolerable and do not increase operative morbidity or mortality when compared with surgery alone. Yet clinical trials have not clearly shown that such regimens improve outcome as measured by survival. Likewise, trials of postoperative chemoradiation have not reported a significant improvement in median or overall survival. The reasons for the lack of clinical benefit from multimodality therapy are not completely understood, but improvements in systemic therapy will probably be necessary before disease-free or overall survival improves substantially. Some new single agents such as the taxanes (docetaxel or paclitaxel) and the camptothecan analog irinotecan have shown modest activity for palliative therapy.
Kelsen
David P
DP
Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weil School of Medicine of Cornell University, New York, NY 10021, USA. kelsend@mskcc.org
D000230:Adenocarcinoma / Q000401:mortality / Q000628:therapy*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000628:therapy*; D004943:Esophagogastric Junction / Q000473:pathology; D006801:Humans; D020360:Neoadjuvant Therapy; D011878:Radiotherapy; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis
D000970:Antineoplastic Agents