State of the art and future perspectives in cytostatic treatment of esophageal cancer

Background: More than two-thirds of patients diagnosed with esophageal cancer will have unresectable disease. Despite advances in diagnostic and surgical techniques and improved pre- and postoperative care, the prognosis of most patients is poor. This review will focus on the use of chemotherapy for patients with metastatic disease. Methods: A computerized (MEDLINE) search was performed to identify papers published on this topic between 1966 and 2006. Results: A total of 55 trials were subsequently identified. Two randomized trials compared palliative chemotherapy with best supportive care in 180 patients with advanced esophageal cancer. Conclusion: Combination chemotherapy as compared to monochemotherapy is associated with significantly higher response rates but nevertheless results in similar survival. CF (Cisplatin and 5-fluorouracil) currently represents one of the most effective regimens for metastatic esophageal cancer, while among the newer combinations, irinotecan or taxane-based regimens have also given promising results. However, confirmatory and adequately powered and designed phase III studies are urgently needed to improve patients' outcomes and for better palliation of symptoms.