The definition of a standard therapy for resectable esophageal
cancer remains a clinical controversy. In the past decade, a variety of
strategies have been developed in an attempt to improve local control
and decrease the all too common problem of distant metastases.
Preoperative treatment with radiotherapy or chemotherapy has been
proved to be feasible, although neither strategy has resulted in
improved survival rates. More recently, concurrent, neoadjuvant
chemoradiation has been utilized with encouraging pathologic responses.
Equally important is the recognition that such aggressive therapy does
not lead to worse surgical outcomes. The evidence for the safety,
feasibility, and efficacy of induction therapy followed by
esophagectomy is presented in the context of developing a rational
methodology to allow for the ongoing modification of standards of care
in the management of this difficult