ABSTRACT
Recent advances in both diagnostic and therapeutic technologies have caused dramatic changes in treatment strategy for esophageal cancer patients. In this lecture, we will introduce the advances in multimodal treatment for esophageal cancer, based on our own experiences. 1. Neoadjuvant chemotherapy (NAC) with Docetaxel/Cisplatin/5-fluorouracil (DCF) for node-positive esophageal cancer. Recently, in Japan, an efficacy of NAC for resectable advanced squamous cell carcinoma of the esophagus has been reported. DCF is expected to be a powerful alternative to cisplatin/5-fluorouracil. Our experience on neoadjuvant or induction DCF will be demonstrated. 2. Efficacy and safety of salvage esophagectomy after dCRT. Salvage esophagectomy is an almost only method to cure the patients with local failure after dCRT, although high mortality and morbidity rates have been reported. We performed 40 cases of salvage esophagectomy during the last 7 years and no hospital mortality has been experienced. Benefit of salvage surgery and procedures to decrease surgical risk will be discussed. 3. Basic research for individualized treatment. If an individualized treatment strategy can be established based on some predictive markers, both improved survival and preserved quality of life will be realized. We will demonstrate the possibility of epigenetic analysis (e.g., LINE-1 methylation level) as biomarkers to predict patient prognosis.