Definitive chemoradiation in the management of locally advanced esophageal cancer

A significant number of patients diagnosed with esophageal cancer will present with locally advanced disease. The appropriate management of these patients continues to be a matter of significant debate. Over the past 2 decades, concurrent chemoradiation has been widely recognized as a viable option for a majority of these patients. Although there have been no randomized trials comparing definitive chemoradiation with surgical resection, there is little doubt that nonoperative therapy offers comparative opportunity for cure with less intendent morbidity and mortality. The broad applicability of this treatment option has led investigators to study methods of maximizing the therapeutic gain associated with the combination of external beam radiation and systemic chemotherapy. The long-term survival results have compared favorably with surgical series, thus leading to clinical trials designed to define the role of surgery in future management strategies. The early evaluation of these recent trials fails to identify any significant advantage associated with the routine use of surgery for most patients. Recent advances in drug development in conjunction with the identification of specific molecular targets has provided new opportunities to improve on the outcomes achieved with standard chemoradiation combinations.