title: Multidisciplinary approach for patients with esophageal cancer.
abstract: Patients with esophageal cancer have a poor prognosis because they often have no symptoms until their disease is advanced. There are no screening recommendations for patients unless they have Barrett's esophagitis or a significant family history of this disease. Often, esophageal cancer is not diagnosed until patients present with dysphagia, odynophagia, anemia or weight loss. When symptoms occur, the stage is often stage III or greater. Treatment of patients with very early stage disease is fairly straight forward using only local treatment with surgical resection or endoscopic mucosal resection. The treatment of patients who have locally advanced esophageal cancer is more complex and controversial. Despite multiple trials, treatment recommendations are still unclear due to conflicting data. Sadly, much of our data is difficult to interpret due to many of the trials done have included very heterogeneous groups of patients both histologically as well as anatomically. Additionally, studies have been underpowered or stopped early due to poor accrual. In the United States, concurrent chemoradiotherapy prior to surgical resection has been accepted by many as standard of care in the locally advanced patient. Patients who have metastatic disease are treated palliatively. The aim of this article is to describe the multidisciplinary approach used by an established team at a single high volume center for esophageal cancer, and to review the literature which guides our treatment recommendations.
authors.affiliation: Department of Medicine, Section Hematology/Oncology, University of Chicago Medicine, Chicago, IL 60637, USA. vvillafl@medicine.bsd.uchicago.edu
authors.forename: Victoria M
authors.initials: VM
authors.lastname: Villaflor
authors.forename: Marco E
authors.initials: ME
authors.lastname: Allaix
authors.forename: Bruce
authors.initials: B
authors.lastname: Minsky
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Herbella
authors.forename: Marco G
authors.initials: MG
authors.lastname: Patti
mesh_terms: D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy / Q000379:methods; D004938:Esophageal Neoplasms / Q000628:therapy*; D016629:Esophagectomy / Q000379:methods; D006801:Humans; D033183:Interdisciplinary Communication; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011878:Radiotherapy / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014481:United States