Chemotherapy of Esophageal Carcinoma

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Abstract
Even today about 90% of patients with esophageal carcinoma will die from their disease. Due to late diagnosis of the disease and early metastatic spread of the tumor, local treatment modalities are curative only for a minority of the patients. Chemotherapy has gained an increasing importance in the treatment of esophageal cancer over the last years. Cisplatin and 5-fluorouracil (5-FU) are most meaningful, but vindesine, bleomycin, etoposide, paclitaxel, and vinorelbine also showed efficacy at least in squamous-cell carcinomas. Only 5-FU and paclitaxel were also effective in adenocarcinomas. The combination of 2 to 4 drugs resulted in increased remission rates, although by randomized trials this could not be translated into improved survival times for patients with advanced disease. Cisplatin/5-FU combination can be regarded as the standard treatment. By now it can not be said whether in this combination a biochemical modulation of 5-FU may be useful. The preoperative chemotherapy proved to be safe in several phase II trials and resulted in tumor downstaging in about 50% of the patients. The current results of phase III studies in resectable tumors did not prove a significant influence of preoperative chemotherapy on long-term survival, although most of these trials are of limited value due to small patient numbers and short observation times at the time of publication. Therefore, appropriate patients with resectable tumors should be treated in randomized trials with a surgery-only control arm. Phase II studies seem to be particularly useful for investigating new drugs or drug combinations in patients with advanced esophageal carcinomas.

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