Combined preoperative radiochemotherapy in squamous cell carcinoma. The view of the medical oncologist

: Early metastases and late diagnosis prevent a relevant chance of curing by unimodal therapy in patients with squamous cell carcinomas of the esophagus. Meta-analyses prove the importance of preoperative radiochemotherapy with regard to local tumor control and overall survival. At present the so-called trimodal therapy is regarded as the international standard treatment. If a response to preoperative therapy can be observed definitive radiochemotherapy without surgery will offer a valuable treatment option particularly for patients with increased postoperative risk. An improvement in current treatment appears possible by introducing EGFR antibodies into future concepts. However, it should not be forgotten that the prognosis of patients is deeply influenced by peri-operative mortality. Therefore, tumor resection after preoperative radiochemotherapy must be restricted to experienced centers, particularly in cases of squamous cell carcinomas.