Current and future strategies in the treatment of esophageal cancer
Esophageal cancer is an aggressive and often lethal disease with an increasing incidence worldwide. Originally, the only potentially curative treatment was esophagectomy. However, outcomes of locoregional advanced disease have improved substantially over the last decades by the incorporation of (neo)adjuvant treatment modalities (chemo- and/or radiotherapy). Advances in radiotherapy techniques and modalities (e.g., proton therapy) facilitate ‘personalisation’ of high dose radiation delivery for patients who are not surgical candidates. As chemoradiation is very effective in a subset of patients leading to pathologically complete responses, the option of active surveillance instead of standard surgery is currently being investigated.
Better patient selection, perioperative care as well as novel surgical techniques have improved the safety and efficacy of surgery. Minimally invasive esophagectomy is increasingly being used and although clear benefits have been described, there is a significant learning curve associated with this complex procedure. How can new surgical innovations be implemented safely now and in the future and what to do with patients who have been treated with definitive chemoradiation therapy?
At some point in time, more than 50% of patients present with metastatic disease. Although survival remains dismal in the majority of these patients, there have been important developments in the treatment of dysphagia and a well selected subgroup of patients might be offered more aggressive multimodal therapy.
Taken together, the treatment of esophageal cancer is rapidly evolving with novel multimodal developments. This special series highlights the recent progress that has been made and hopefully this will translate into a more bright future for our patients.
Acknowledgments
Funding: None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Esophagus for the series “Novel Developments in the Multimodality Treatment of Esophageal Cancer”. The article did not undergo external peer review.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/aoe-2020-51). The series “Novel Developments in the Multimodality Treatment of Esophageal Cancer” was commissioned by the editorial office without any funding or sponsorship. SL, BW and FL served as the unpaid Guest Editors of the series. The authors have no other conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
Cite this article as: Lagarde S, Wijnhoven B, Lordick F. Current and future strategies in the treatment of esophageal cancer. Ann Esophagus 2021;4:34.
