The optimal management of locoregional esophageal cancer is controversial. Preoperative concomitant chemoradiotherapy (two courses of cisplatin and 5-fluorouracil plus 50 Gy of radiation) may provide benefit in survival and local control compared with surgery alone and is a reasonable alternative to surgery alone in stages IIB, III, and possibly stage IVa disease. This benefit is less clear in stages I and IIA, for which surgery alone is thus a reasonable option. Preoperative chemotherapy without radiation also provides a survival benefit compared with surgery alone, but data are insufficient to conclude it is superior to preoperative chemoradiotherapy. Control of distant disease remains a problem with preoperative chemotherapy and preoperative chemoradiotherapy.
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