Esophagectomy After Induction Chemoradiation

The definition of a standard therapy for resectable esophagealcancer remains a clinical controversy. In the past decade, a variety ofstrategies have been developed in an attempt to improve local controland decrease the all too common problem of distant metastases. Preoperative treatment with radiotherapy or chemotherapy has beenproved to be feasible, although neither strategy has resulted inimproved survival rates. More recently, concurrent, neoadjuvantchemoradiation has been utilized with encouraging pathologic responses. Equally important is the recognition that such aggressive therapy doesnot lead to worse surgical outcomes. The evidence for the safety, feasibility, and efficacy of induction therapy followed byesophagectomy is presented in the context of developing a rationalmethodology to allow for the ongoing modification of standards of carein the management of this difficultdisease.