Esophageal cancer is a virulent
malignancy, with the conventional approach of surgery or
radiation therapy offering patients only a small chance for long-term disease-free survival. The frequent early systemic dissemination of disease has prompted an ongoing interest in the study of
chemotherapy. A broad range of
antitumor agents have been studied which demonstrate moderate antitumor activity. A number of
combination chemotherapy regimens, mainly
cisplatin-based, have been studied, which have consistently greater antitumor activity in local regional disease compared with metastatic disease. The use of preoperative
chemotherapy in the surgical treatment of the disease remains investigational. Results from clinical trials comparing
radiation therapy alone with concurrent radiation and
chemotherapy demonstrate a survival benefit for the use of a combination of concurrent
chemotherapy and radiation compared to
radiation therapy alone. However, current studies with conventional
chemotherapy, radiation and surgery are likely to impart at best a modest to moderate improvement in the treatment of esophageal
carcinoma. The priority in
chemotherapy trials, therefore, remains the identification of new active
chemotherapy agents. The search for novel therapeutic approaches, exploiting advances in understanding of the molecular biology of the disease, continues.