Esophageal cancer: optimization of treatment strategies

Esophageal cancer is a highly lethal disease with a poor prognosis. Roughly half of patients present with locally advanced disease without distant metastases and can be treated with curative intent. The current standard of care for these patients is neoadjuvant chemoradiotherapy (nCRT) or chemotherapy followed by esophagectomy. After first publication of the CROSS trial, most countries implemented this nCRT regimen as standard of care. In this thesis, new insights into the treatment of locally advanced esophageal cancer are discussed. In part I, the long-term results of the CROSS trial are described and the effect of this neoadjuvant regimen in specific groups is addressed. In part II, open, hybrid and totally minimally invasive Ivor Lewis esophagectomy are compared in terms of surgical morbidity, lasting symptoms and long-term quality of life. In part III, different diagnostic modalities for clinical response evaluations after nCRT are discussed and the feasibility of active surveillance is addressed.