Neoadjuvant therapy of esophageal carcinoma.

To quote Steiger, the "multimodality treatment of esophageal cancer brings creativity and imagination to a field of medicine plagued with failure." However, acceptance of neoadjuvant chemotherapy or chemoradiotherapy as routine must await the results of large phase III studies. Even with a positive response, many questions will remain. The ability to stage patients more accurately might allow us to apply neoadjuvant therapy with more discrimination. The role of radiation therapy--the fractionation schedule, total dose, and sequencing--will require evaluation. Creativity and innovation must be applied to the quest of predicting who will respond to neoadjuvant treatment. Better drug combinations and methods to reduce toxicity must be sought. The neoadjuvant therapy of esophageal cancer is a field requiring continued rigorous scientific investigation, honesty, and hope.