Multimodal treatment of oesophageal cancer

Treatment of oesophageal cancer requires a multidisciplinary approach. Single modality treatment, especially surgical excision, is only indicated in small tumours or in patients unable to support multimodal treatment. In Stage I–II adenocarcinoma, multimodal treatment using neoadjuvant therapy is indicated in the absence of contra-indications. However, this statement is not universally accepted. The choice between radio-chemotherapy and chemotherapy depends on patients’ characteristics and the preferences of the treatment centre. In selected Stage III adenocarcinomas, especially from the lower oesophagus, neoadjuvant chemotherapy (with post-operative chemotherapy when feasible) may induce tumour regression, which may facilitate surgical resection and improve survival rates, as has been demonstrated for cancers of the oesophagogastric junction.