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Impact of multimodality therapy in esophageal cancer on disease, patient and treatment
Book - Dissertation
Multimodality treatment in potentially curable locally advanced esophageal cancer (EC) and cancer of the gastro-esophageal junction (GEJC) is standard practice in most patients because it is improving local control and survival in the majority of patients. We hypothesize that multimodality treatment in these patients is not always synonym of improved outcome compared to primary surgery on one hand, but on the other hand, multimodality treatment could potentially be beneficial in a group of EC and GEJC patients previously deemed palliative.In a first part the histological effects of multimodality treatment on patients' survival and the prognostic value of these microscopical findings in the esophagectomy specimen is determined in five separate studies: the effect of the treatment on the histologic resection margin, the response on the primary tumor and the response on the lymph nodes. These various outcomes are compared to the patients' overall and disease free survival.In a second part, the selection process of EC or GEJC patients starting multimodality treatment is studied. The question is asked where this process is to be improved. In the first study, patients who eventually did not proceed to surgery, are investigated. The last two studies will handle the potential role of multimodality treatment in case of progressive disease; synchronous and metachronous.