Palliative and supportive therapy of esophageal cancer

The prognosis for patients with advanced esophageal cancer is poor and palliative therapy for these patients necessitates a broad spectrum of different measures to relieve symptoms. However, the increasing knowledge of tumor biology of adenocarcinoma and squamous cell cancer of the esophagus may facilitate improved treatment options. Local treatment modalities include endoscopic stenting and hemostasis, radiotherapy and very rarely palliative resection. Systemic chemotherapy usually combines two or three cytotoxic drugs with the aim to improve prognosis and possibly to alleviate symptoms. In patients with unresectable or metastatic esophageal cancer, multimodal treatment (i.e. radiotherapy, chemotherapy, combined radiochemotherapy, palliative and supportive care) should be individualized and conducted within all subspecialties (tumor board conferences). The choice of the procedure is based on the symptoms, the tumor situation, the patients' general status and patient preferences. If possible an individual, interdisciplinary treatment concept should be designed for each patient and modified according to the course of the disease.