Multimodality therapy for the curative treatment of cancer of the esophagus and gastroesophageal junction.

This review examines the role of combined-modality therapy in the treatment of locally advanced esophageal cancer. While surgery remains a cornerstone of treatment, recent studies have demonstrated that pre- or perioperative chemotherapy is associated with improved survival. Primary chemoradiotherapy is the accepted standard of care for medically inoperable patients. Neoadjuvant chemoradiotherapy continues to be investigated and is associated with several advantages over neoadjuvant chemotherapy alone, including an improvement in the pathologic complete response rate and resectability; patients who achieve a pathologic complete response also appear to have improved survival. Adjuvant chemoradiotherapy may be considered for patients who undergo primary resection of lower esophageal/gastroesophageal junction adenocarcinoma. Future directions include the investigation of novel chemotherapy regimens, the addition of targeted therapies and the use of PET to provide an early assessment of response.