Esophageal cancer: is esophagectomy necessary?

A prospective randomized trial of primary surgery versus primary radiotherapeutic management of esophageal cancer has never been completed. Selection of the optimal modality for primary management of esophageal cancer is important to maximize local control, palliation and survival with minimal morbidity, mortality and cost. Chemotherapeutic agents are effective in esophageal cancer and some may act synergistically with radiation to enhance local control. When chemotherapy is given concurrently with low-dose radiation, about one-quarter to one-third of the patients have no evidence of cancer in the resected specimen and it is only in this group of patients that there are long-term survivors. Thus the author questions the need for esophagectomy. Nonsurgical management of esophageal cancer employing high-dose radiation and concurrent chemotherapy has produced high local control and palliation with median survival of 1 1/2 to 2 years.