Cancer of the esophagus and cardia: overview of radiotherapy.

Cancers of the esophagus and cardia are aggressive; they behave similarly and are associated with an extremely poor prognosis. Because current treatments (surgical esophagectomy and irradiation) have failed to cure the disease, critical analysis is needed to determine the reasons for this failure. The following problems in disease management have been identified: (a) most patients are old, frail, undernourished and have locally advanced disease at the time of diagnosis, (b) 80% of patients die of locally recurrent disease and aspiration pneumonia caused by the persisting cancer, (c) there is no consensus as to what constitutes the optimum curative treatment for the disease and (d) there is no agreement on the technical aspects and extent of the surgical treatment required or on radiotherapy.