Lawrence Leichman, MD

Theoretically, effective regional cancer chemotherapy should afford the opportunity to deliver a significantly higher concentration of a cytotoxic agent than is possible with systemic administration of the same agent. Furthermore, regional chemotherapy should cause its greatest stress on the site of administration, producing a lesser burden of toxicity on the whole body.

Although therapy for esophageal cancer has generated a profusion of research programs and clinical trials, difficult issues and important questions remain to be addressed and answered. The scholarly, balanced review of esophageal cancer by Drs. Ilson and Kelsen explores these issues and questions in a state-of-the art summary of treatments for this disease. The authors hold impressive credentials in this field: almost all clinical research in esophageal cancer for the past two decades owes some debt to Dr. Kelsen and his colleagues at Memorial Sloan-Kettering Cancer Center. In this commentary, we will utilize a few of the key points raised by the authors to suggest a slightly different perspective on approaches to esophageal cancer treatment and directions for future research endeavors.