Crash summary of stage I-III esophageal cancer treatment

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Esophageal cancer is a disease with an extraordinarily high risk of recurrence after surgical resection. Preoperative chemoradiation followed by surgery was established as the standard of care for locally advanced esophageal cancer (T3 tumors or positive lymph nodes) in the CROSS trial investigating radiation (41.4 Gy) given with weekly carboplatin (AUC=2) and paclitaxel (50 mg/m2) followed by surgery compared to surgery alone. Five year survival rates were increased from 34% with surgery alone to 47% with trimodality therapy. Esophagectomy alone is appropriate for early stage disease (T12, N0). Definitive chemoradiation has an excellent cure rate in early stage squamous cell carcinomas, but adenocarcinomas are unlikely to be cured with chemoradiation alone.
It is important to recognize the benefit of trimodality therapy in locally advanced adenocarcinoma of the esophagus. If this tumor were a squamous cell carcinoma, could consider definitive chemoradiation with 5FU and cisplatin. Early stage esophageal adenocarcinoma could be considered for esophagectomy alone, but more advanced disease should be treated with trimodality therapy. 

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