24 Oesophageal Cancer

Oesophageal cancer occurs in older patients and is associated with a prolonged history of smoking and drinking. Classical treatment for early disease is surgery, preceded by preoperative chemoradiation in selected cases. In patients for whom surgery is not possible, e.g. because of tumour location or anaesthetic risk, an alternative treatment for early disease is external beam therapy followed by brachytherapy as a boost. Advanced stages have a poor prognosis and are usually treated with palliative (chemo-)radiation in patients with good performance status. Radiation therapy alone is given externally, or in combination with brachytherapy in patients with poor performance scores not likely to tolerate an aggressive chemoradiation regimen. In addition brachytherapy alone may be used for advanced/recurrent disease or in patients with luminal obstruction.