Current treatment approach to locally advanced esophageal cancer: is resection mandatory?

Ongoing controversy surrounds the question of whether locally advanced cancer of the esophagus should be resected or treated with nonsurgical methods. Survival after resection, particularly of patients with squamous cell cancer, remains poor. Results of recent studies suggest that in cases of squamous cell cancer there is no clear survival advantage favoring surgery, but local tumor control is significantly improved after resection. Besides this clinically relevant difference, important issues concerning the design and conduct of the most recent studies have not been investigated carefully and deserve critical discussion. Of particular note is the fact that surgery has not yet been compared with a nonsurgical approach in treating adenocarcinoma of the esophagus. Consequently, surgery remains the standard approach, at least for this cancer subtype. Response to induction chemotherapy and radiation will determine future treatment algorithms, and promising tools for predicting response are currently being investigated.