Treatment approach to localized esophageal cancer - What have we learned so far?

The treatment of localized esophageal cancer (LEC) is under extensive debate. Treatment approaches include surgery or radiation alone, surgery with preoperative or postoperative radiation, preoperative or postoperative chemotherapy and definitive or preoperative chemoradiation. In fact, the type of therapy patients receive is often dependent on the actual medical field of the treating physician (surgery, oncology, etc.). The use of multiple treatment approaches toward LEC primarily reflects the scarcity of data that is derived from controlled randomized trials and the poor results of current therapies. In spite of the above, the cumulative data suggest that surgery and chemoradiation are the two treatment options in LEC and that their combined approach, i.e. preoperative chemoradiation, has not been proven to have a survival advantage over each one of these methods, and should therefore still be considered investigational. This article will review the available data on the various treatment approaches that are being used against LEC.