New approaches to treating oesophageal cancer

Currently the prognosis for patients with oesophageal cancer is poor. On the basis of a review of 122 articles published between 1954 and 1978 Earlam and Cunha-Melo estimated that of 100 patients with squamous cell carcinoma of the oesophagus, 58 had exploratory surgery, of whom 39 had surgical resection and 26 left the hospital with their tumours excised. Eighteen patients were alive at one year, nine at two years, and four at five years.1 The reasons for such poor surgical results include inadequate preoperative staging and the morbidity and mortality of treatment. The most important explanation, however, is that most cases of oesophageal cancer have metastasised by the time that symptoms develop.2

Squamous cell carcinoma has been the predominant histological subtype,3 but the incidence of oesophageal adenocarcinoma is now rising in Britain4 and the United States.5 Although resectability and survival for both histological types are similar,6 reports of their relative responsiveness to radiotherapy are conflicting3 and their relative responsiveness to …