Given the discouraging outcome of surgical resection, multimodality therapy using preoperative radiation, chemotherapy, or a combination of the two has been tried in a number of studies. Theoretically, compared with surgery alone, multimodality therapy should result in improved regional control as well as distant control of micrometastases. Despite this theoretical advantage, the role of multimodality therapy remains controversial. Of course, toxic effects are associated with irradiation and chemotherapy. These side effects can significantly reduce the quality of life in patients with limited life expectancy, so therapeutic options should be thoroughly discussed with patients.
Palliation is the primary goal in patients with advanced disease or metastasis.
Therapy should focus on relief of pain and improvement in swallowing. Chemotherapy, radiation therapy, endoscopic interventions, and surgery may all play a role in improving quality of life in these patients. Nonsurgical options should be considered carefully before contemplating operative palliation. External-beam irradiation is very effective in rapidly relieving obstructive symptoms and restoring swallowing ability. A variety of endoscopic therapies are available for palliation.