How is locally advanced cancer of the esophagus treated?

Patients with locally advanced esophageal cancer who are in excellent condition may be treated in several ways. However, the most common treatment for patients with locally advanced adenocarcinomas of the distal esophagus or gastroesophageal (GE) junction in many major medical centers involves preoperative concurrent chemoRT (chemotherapy during the course of radiotherapy) delivered over an approximately six-week course, followed by a several week break, then surgery. This trimodality therapy gives patients with locally advanced disease a reasonable chance for cure. Roughly 15% to 20% of patients who undergo preoperative chemoRT are found at the time of surgery to have no residual living cancer cells, when the pathologist looks at the surgical specimen under the microscope. This favorable situation is called a pathologic complete response (pCR). Again, PET/CT scan performed between chemoRT and surgery can often predict the response as well as long-term survival. Patients who get a pCR after chemoRT have a better chance for long-term survival than those who have residual disease at the time of surgery.