Esophageal cancer is still the leading cause of cancer-related death in the world, but although in the last few decades, there has been an increase in long-term survival for these tumors, it still stands altogether at around 20% at 5 years for patients treated, and, unfortunately, more than 50% of the patients who come to observation present with locally advanced or non-resectable tumors. The aging population and a longer life expectancy have led to a significant increase of elderly patients being referred for treatment. For many patients, and particularly for esophageal cancer, surgery is still the main treatment, and esophagectomy is the major surgical procedure. Although burdened by a high incidence of morbidity and mortality, the effect of age on the outcome of these patients is still controversial.
The improvement of anesthetic techniques and postoperative pain control, especially the introduction into clinical practice of assessing the fragility of the elderly patient, has allowed, even in aggressive treatment protocols, a growing number of elderly patients to enlist with results, in terms of morbidity and mortality, similar to those of younger patients.
Proper treatment planning for cancer of the esophagus is influenced by numerous factors (staging, grading, and performance status of patients). The most appropriate treatment protocol must take into account, first of all, the involvement of the wall that appears to be strongly associated with the presence of lymph node involvement and distant metastases in order to plan the most appropriate therapeutic approach which would guarantee the best results in terms of morbidity and survival rate in relation to the patient’s performance status.
The combined use of chemotherapy and radiotherapy, unlike the neoadjuvant trimodality therapy, showed that this protocol is important to understage disease with pathological complete response (pCR) ranging from 20 up to 40%. For these reasons the multimodality therapy has become the foundation for treatment of the majority of patients with cancer of the esophagus and cardias. The treatment approach depends on several factors and requires a team of specialists.
KeywordsSquamous cell carcinoma Adenocarcinoma of the esophagus Cardia Therapy SCC EAC Elderly
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