Locally advanced esophageal cancer, potentially curable with surgery or radiotherapy-based treatment, has a poor prognosis because of the eventual development of systemic metastatic disease in the majority of patients. Local recurrence of disease after local treatment modalities is equally problematic. The use of systemic chemotherapy in the surgical and radiation-based treatment of esophageal cancer is reviewed, including the approach of preoperative chemotherapy, preoperative concurrent chemotherapy plus radiotherapy, and chemoradiotherapy as definitive treatment without surgery. The use of chemoradiotherapy has clearly been shown to be superior to radiotherapy alone in the nonsurgical management of locoregional esophageal cancer. Recent trials suggest that preoperative chemoradiotherapy may be superior to surgery alone but trials are ongoing to better define the role of combined modality therapy in the surgical management of esophageal cancer.
