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World J Gastroenterol. Dec 14, 2012; 18(46): 6737-6746
Published online Dec 14, 2012. doi: 10.3748/wjg.v18.i46.6737
Multidisciplinary approach for patients with esophageal cancer
Victoria M Villaflor, Marco E Allaix, Bruce Minsky, Fernando A Herbella, Marco G Patti
Victoria M Villaflor, Department of Medicine, Section Hematology/Oncology, University of Chicago Medicine, Chicago, IL 60637, United States
Marco E Allaix, Fernando A Herbella, Marco G Patti, Department of Surgery, University of Chicago Medicine, Chicago, IL 60637, United States
Bruce Minsky, Radiation Oncology, University of Chicago Medicine, Chicago, IL 60637, United States
Author contributions: Villaflor VM, Allaix ME, Minsky B, Herbella FA and Patti MG designed and revised the manuscript; Villaflor VM wrote the manuscript.
Correspondence to: Victoria M Villaflor, MD, Department of Medicine, Section Hematology/Oncology, University of Chicago, 5841 S Maryland MC2115, Chicago, IL 60637, United States.
Telephone: +1-773-7022825 Fax: +1-773-7020963
Received: April 18, 2012
Revised: November 19, 2012
Accepted: November 24, 2012
Published online: December 14, 2012

Patients with esophageal cancer have a poor prognosis because they often have no symptoms until their disease is advanced. There are no screening recommendations for patients unless they have Barrett’s esophagitis or a significant family history of this disease. Often, esophageal cancer is not diagnosed until patients present with dysphagia, odynophagia, anemia or weight loss. When symptoms occur, the stage is often stage III or greater. Treatment of patients with very early stage disease is fairly straight forward using only local treatment with surgical resection or endoscopic mucosal resection. The treatment of patients who have locally advanced esophageal cancer is more complex and controversial. Despite multiple trials, treatment recommendations are still unclear due to conflicting data. Sadly, much of our data is difficult to interpret due to many of the trials done have included very heterogeneous groups of patients both histologically as well as anatomically. Additionally, studies have been underpowered or stopped early due to poor accrual. In the United States, concurrent chemoradiotherapy prior to surgical resection has been accepted by many as standard of care in the locally advanced patient. Patients who have metastatic disease are treated palliatively. The aim of this article is to describe the multidisciplinary approach used by an established team at a single high volume center for esophageal cancer, and to review the literature which guides our treatment recommendations.

Keywords: Esophageal Cancer, Multimodality therapy, Multidisciplinary therapy, Chemoradiotherapy, Esophageal resection, Esophagectomy