Treatment of oesophageal cancer

Mr D C Britton seems to perpetuate the myth (October 2001 JRSM, pp. 500-501) that surgical resection is the only possible radical treatment for oesophageal carcinoma—‘in the remainder, only symptomatic relief can be offered, perhaps by intubation or palliative radiotherapy.’ However, several studies have now confirmed that radical radiation therapy, or better still concurrent chemoirradiation, can also cure^1,2. In the recent long-term follow-up study by Cooper and colleagues, of a randomized study of radiation alone versus concurrent chemoirradiation therapy, the latter proved superior, despite the trialists' bold move in deliberately reducing the radiation dose in the chemoirradiation arm to avoid undue toxicity. This was true for both squamous cell carcinomas and adenocarcinomas.

Radical non-surgical treatment has other advantages— notably, avoidance of the early perioperative mortality (often quoted at around 5%, even in highly experienced hands) and also the many non-fatal but hazardous long-term complications of oesophagectomy^3,4. With improvements in diagnostic imaging, coupled with laser recanalization through an obstructed oesophageal lumen, an everincreasing proportion of patients have become candidates for radical non-surgical treatment. The oesophagus is one of several sites in which synchronous chemoirradiation has now become a standard therapy for surgically inoperable cancers⁵.