Erschienen in:
01.09.2014 | Thoracic Oncology
Three Angels are Dancing on the Head of the Esophageal Cancer Pin, but Shouldn’t We Not Topple One or Two?
verfasst von:
Jaffer A. Ajani, MD, Stephen G. Swisher, MD
Erschienen in:
Annals of Surgical Oncology
|
Ausgabe 9/2014
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Excerpt
The burden of esophageal cancer (EC) is great around the globe.
1,
2 Although adenocarcinoma is on the rise in the West, squamous cell carcinoma of the esophagus is rampant in the endemic areas.
3 Even when EC is localized, it presents numerous challenges for the patients, their family, and the team of caretakers. Therapies are often associated with considerable morbidities and lifestyle alterations that are often quite uncomfortable. Localized EC is best treated after a multidisciplinary evaluation and discussions at a high-volume center. Patients with stage II or III EC are often offered a combination of chemotherapy, radiation, and/or surgery based on comorbid conditions, resectability, and geographical distribution of EC. There is well-established evidence to recommend definitive chemoradiation
4,
5 or chemoradiation followed by surgery,
5,
6 but the data is less convincing for chemotherapy followed by surgery (and more so for chemotherapy postsurgery).
7,
8 Surgery alone for clinical stage II or III EC, irrespective of histology (squamous cell carcinoma or adenocarcinoma), universally leads to poor outcome,
9 and this strategy should be abandoned if facilities exist to deliver effective radiation therapy and chemotherapy. …
