Proximal esophageal cancer

Cancer of the upper part of the esophagus occurs in 1 in 20 patients with esophageal cancer and is therefore a rare condition. The cornerstone of cancer treatment in general is surgical removal. However, in cancer of the upper part of the esophagus, surgery is no easy task and can be highly mutilating. This doctoral study examined the treatment options available to these patients and the outcomes they provide. It was determined that the risk of dying from this disease decreased, where in 1989-1994 only 1 in 20 patients were alive 5 years after diagnosis, this has increased to 1 in 8 patients in 2010-2014. This gain is mainly explained by the entry of combined treatment of chemotherapy and radiotherapy ("chemoradiation"). The survival of patients treated with surgery or chemoradiation was more or less the same. Because chemoradiation leads to less severe complications than surgery, the use of chemoradiation without surgery is currently the best treatment modality. It was also investigated which combination of chemotherapy and radiotherapy gave the best outcomes. It was concluded that the different regimens gave no difference in survival, but that carboplatin plus paclitaxel chemotherapy and low dose radiotherapy (≤50 Gy) resulted in fewer side effects.