Cancer of the oesophagus—how should tumour biology affect treatment?

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Abstract
Summary: An analysis of the biology of cancer of the oesophagus suggests that significant dissemination may not have taken place at the time of diagnosis in approximately one-third of cases. Positive nodal histology in the mediastinum or abdomen is the best available evidence of disseminated disease. Patients without such nodal involvement there-fore represent a group in whom the disease is most likely to be localized. It is suggested that only these patients be subjected to aggressive local therapy. The effects of no treatment, ortho- and megavoltage radiotherapy, surgery and combinations of surgery and radiotherapy are reviewed. The need for cooperative randomized clinical trials to test the biological hypothesis outlined is discussed. Megavoltage radiotherapy as a primary treatment for oesophageal cancer followed by radical surgery in those patients without evidence of dissemination from nodal histology is proposed as a basis for such clinical trials.

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