An expert opinion on esophageal cancer therapy.

INTRODUCTION: Worldwide, esophageal cancer (EC) is the seventh leading cause of cancer-related death, with its incidence increasing in the US, where a change in its epidemiology has been noted. Most patients present with regional or distant disease and, therefore, have a very poor prognosis. AREAS COVERED: Progress made over the last 20 years in the diagnosis, staging and management of EC is focused on in this review, with the emphasis on locally-advanced disease treated with curative intent. Evidence is reviewed from prospective randomized trials and meta-analyses and data are presented regarding new therapy with targeted agents. Although surgery has been the mainstay of treatment for EC, survival with this approach alone remains disappointing. As a result, combined modality treatment (CMT) including chemotherapy and radiation has been incorporated into the treatment paradigm for both operable and inoperable disease. The evidence supporting CMT for EC, the role of surgery at different stages, and how treatment strategies differ based on histology are outlined. EXPERT OPINION: Trends in 5-year overall survival rates over the last 30 years have increased (from 5 to 17%), suggesting that small, yet significant, improvements in diagnosis, staging, treatment and supportive care are being made. Clearly, the choice of treatment should be guided by disease stage, histology and patient co-morbidities.