Optimal therapy for oesophageal cancer.

Oesophageal carcinoma is one of the commonest cancers in the world and has an increasing incidence in Western civilisation. As the epidemiology of the disease has changed so too has our treatment strategies. The present standard of care is surgery but this is associated with disappointing survival figures. The role of chemotherapy and radiation is now established in inoperable disease. How best to deliver these modes of therapy has yet to be defined. Extrapolation of data from previous trials is difficult as these trials have many deficiencies and do not account for recent advances in therapeutics or techniques of delivery. The role of chemo-radiotherapy in operable disease is even more controversial. A number of prospective randomised trials of trimodality therapy versus surgery alone suggests a benefit for multimodal therapy. These trials also reveal evidence to support the use of chemo-radiotherapy alone in a subset of patients with resectable disease. The appropriate application of these varied therapeutic interventions remains unanswered. Further progress in diagnostic techniques and predictive markers may allow us to stratify patients into different treatment groups. Continued investigation is required to keep pace with the evolution of oesophageal cancer and its therapy. This will facilitate a better understanding of the disease and optimise the treatment offered to patients.