Options for the treatment of esophageal cancer used to be very limited, with surgical resection and radiotherapy methods aimed at both cure or palliation, and, in those unfortunate patients with severe dysphagia, intubation with a plastic prosthesis to restore esophageal luminal patency. Progress in the management of this cancer in the past two decades includes refinement in surgical techniques and perioperative care, better radiological staging methods, enhanced means of planning and delivering radiotherapy, multimodality treatments, and better designs in esophageal prosthesis. For individual patients, a stage-directed therapeutic plan can be used. Long-term survival, however, remains suboptimal for this deadly disease. The current review presents an overview of the commonly employed therapeutic options for esophageal cancer at the beginning of the 21st century.
There used to be only three treatment options for patients suffering from esophageal cancer: surgical resection, external irradiation therapy, and intubation with plastic prosthesis. For those with terminal disease, a gastrostomy tube was often inserted. This was an unsatisfactory procedure for it merely prolonged life without meaningful palliation. The past two decades have seen a proliferation of therapeutic options for esophageal cancer. Surgical resection has been refined, techniques of radiation improved, neoadjuvant or adjuvant therapies with chemotherapy and/or radiotherapy added, and various new methods of endoscopic procedures made available for palliation. For each patient, the best single or combination of treatments has to be individualized. The present review evaluates the various treatment modalities currently available.