The multidisciplinary management of gastrointestinal cancer. Multimodal treatment of oesophageal cancer.

Treatment of oesophageal cancer requires a multidisciplinary approach. Single modality treatment, especially surgical excision, is only indicated in small tumours or in patients unable to support multimodal treatment. In Stage I-II adenocarcinoma, multimodal treatment using neoadjuvant therapy is indicated in the absence of contra-indications. However, this statement is not universally accepted. The choice between radio-chemotherapy and chemotherapy depends on patients' characteristics and the preferences of the treatment centre. In selected Stage III adenocarcinomas, especially from the lower oesophagus, neoadjuvant chemotherapy (with post-operative chemotherapy when feasible) may induce tumour regression, which may facilitate surgical resection and improve survival rates, as has been demonstrated for cancers of the oesophagogastric junction.