Chemotherapy in cancer of the esophagus

Al though cancer of the esophagus has been recogni zed as a fatal disease as long ago as the start of the Christian era, the present outlook remains dismal. Less than 10 percent of patients with seemingly localized disease, surgically treated with curative intent, will survive five years or more. Dysphagia, the initial symptom in most patients, usually occurs late in the course of the disease, when the esophageal wall has been infiltrated or penetrated. At this time, in the majority of patients, metastases are present in surrounding lymphe nodes and/or other organs. Until recently, chemotherapy had no role in the treatment of this disease. It was generally used as a last resort I after primary surgery or radiation therapy, in patients with a poor performance status. With the availability of new drugs, used in various combinations, and sometimes in conjunction with other forms of cancer treatment, a modest success is standing out against the horizon. This thesis includes an overview of the current knowledge on chemotherapy in esophageal cancer (chapter 1), several clinical studies on the efficacy and toxicity of various drugs and combinations of drugs in metastatic esophageal cancer (chapters 2-5), a comparative study on preoperative chemotherapy in patients with operable esophageal cancer (chapter 6) I and an exploratory study, after chemotherapy to evaluate the benefit of (chapter 7) in patients salvage surgery with metastatic esophageal cancer. In addition, two laboratory experiments on the presence of human papilloma virus and the role of the Multidrug Resistance Protein in esophageal cancer are covered (chapters 8,9).

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