Chemoradiation: A Superior Alternative for the Primary Management of Esophageal Carcinoma

There have been no randomized studies of esophagectomy versus chemoradiation as primary management of esophageal cancer. Review of the literature indicates esophagectomy alone has limited applicability, significant morbidity, higher mortality, and a lesser chance for cure than chemoradiation for patients with squamous cell cancer of the esophagus. The majority of patients with esophageal cancer have disease extending through the esophageal wall or nodal involvement and the prognosis for such patients treated by esophagectomy alone is quite poor, with 5-year survival rate of 10% or less. Recent studies indicate 5-year survival rates with chemoradiation is 20% to 25%. Local failure rates are similar with chemoradiation versus esophagectomy, but swallowing function is superior with chemoradiation. Salvage surgery is possible following chemoradiation for the small percentage of patients who have local-only failure. Chemoradiation is preferred to esophagectomy for patients with squamous cell cancer of the esophagus, and offers significant palliation and the chance for cure for patients with adenocarcinoma of the esophagus as well.