The present status and future potential of radiotherapy in the management of esophageal cancer.

The management of 2032 patients with squamous esophageal cancer seen in Edinburgh from 1931 to 1969 was studied. Since 1949 more radical surgical treatment has been offered and since 1956 more radical radiotherapy. From 1949 to 1969 there has been a swing over from mainly surgical to mainly radiation treatment associated with a rise in the overall one and five-year survival rates to 32% and 9% respectively. The main reason for failure is the prevalence of disseminated disease. The significant mortality of surgical treatment limits its usefulness. Too often, radiotherapy fails because of recurrence of tumor within the irradiated volume. In the upper 2/3 of the esophagus irradiation is preferable to surgery because of better sirvoval. In the lower 1/3 the two methods achieve similar long term survival but following irradiation the short term survival is better and the patient retains a normal stomach. Improvement could be achieved by prevention, earlier diagnosis, improved tumor delineation and a wide range of measures to improve the local effectiveness of irradiation.