The incidence of
adenocarcinoma of the distal esophagus or esophagogastric junction has increased considerably in Western countries during the past 3 decades, whereas the incidence of
squamous-cell carcinoma has decreased slightly. In Japan, most
esophageal cancers are
squamous-cell carcinomas. Endoscopic examinations are more frequently performed in Japan for routine screening and diagnosis and treatment than in other countries, thereby increasing the detection rate of superficial esophageal
carcinomas. In Europe and North America, many clinical trials have been conducted to assess the effectiveness of
neoadjuvant chemoradiotherapy followed by surgery in patients with resectable, advanced
esophageal cancer. In Japan, surgical resection had been the mainstay of treatment for
esophageal cancer. Since the results of the Japan Clinical Oncology Group (JCOG) 9907 study were reported,
neoadjuvant chemotherapy with
cisplatin plus
5-fluorouracil followed by surgery has emerged as a new standard treatment. As for definitive
chemoradiotherapy,
cisplatin,
5-fluorouracil, and concurrent
radiotherapy dosed to 50.4 Gy are used as standard treatment in a randomized clinical trial performed in North America. In patients who have T4
tumors and/or M1
lymph-node metastasis,
chemoradiotherapy with
cisplatin and
5-fluorouracil is considered standard treatment, but
docetaxel,
cisplatin, and
5-fluorouracil plus concurrent
radiotherapy is also being studied. Controlled studies have not shown that palliative
chemotherapy is superior to best supportive care, but
cisplatin plus
5-fluorouracil is still considered standard
therapy. Clinical trials of targeted agents are in progress. It is hoped that targeted agents will be effective for
esophageal cancer.