Treatment of locally advanced esophageal cancer with surgery and chemoradiation

Purpose of review This article reviews developments in the treatment of locally advanced esophageal cancer with surgery and chemoradiation published in 2007. Recent findings Overall long-term survival is the same for patients after transhiatal or transthoracic esophagectomy. The pathology report of the resected specimen should contain information on lymph node status, such as size, location and lymph node ratio. If surgery is performed in patients with advanced esophageal cancer, there is small survival advantage if combined with neoadjuvant therapy, that is chemoradiation. Prognostic factors are a good performance status, a major response to chemoradiation and an early metabolic response with fluorine-18 fluorodeoxyglucose PET. Definitive chemoradiation may have similar results as combination treatment including surgery in selected patients with esophageal squamous cell cancer. Salvage surgery should be considered if definitive chemoradiation fails, provided that an Ro resection can be performed. Nutritional status is a prognostic factor in patients undergoing treatment of esophageal cancer. Summary In 2007, refinements of the nodal status in the tumor, node, metastasis system were proposed. Chemoradiation followed by surgery is increasingly being used in patients with advanced esophageal cancer. Evidence suggests that definitive chemoradiation could be a reliable treatment option in selected patients with esophageal squamous cell cancer.