High rates of esophageal cancer in advanced stages and poor short- and long-term results with surgical treatment have led to the use of combined treatment regimens. There is, however, no unanimity as to the most effective preoperative therapy or the most effective therapeutic tactics. In combined therapy we are in favor of strict compliance with the sequence of abdominal exploration, radiotherapy, and finally surgery. A differentiated approach according to the resectability of the lesion should be maintained. With regard to metastatic spread, nodes located in the paracardiac area and lesser omentum must be regarded as regional for the thoracic esophagus. Thirty percent of patients with metastases to these nodes survive more than 5 years after combined therapy. Based on our extensive experience in combined therapy plus an analysis of the literature we have formulated the features that will indicate palliative surgery. Differentiation between types of operations serves to determine more accurately the prognosis and the planning of further therapeutic tactics. With palliative surgery adjuvant treatment must always be given.

Combined Modality Therapy↗

PubMedDate not supplied

[Intraoperative radiation therapy: its technological support, potentials and prospects].

The authors' experience with intraoperative radiotherapy (IORT) in 129 patients with a tumorous process at various sites has demonstrated that in most clinical events, single radiation doses of 10-20 Gy is insufficient to have a persistent local effect and requires additional pre- or postoperative remote irradiation. The use of IORT as a single component of radiation exposure does not lead to significant radiation damages to normal tissues. When IORT is combined with remote irradiation (the latter using doses of 30-60 Gy), 30% of patients develop radiation-induced normal tissue lesions. In the context of enhancing the local effect and, if possible, decreasing the dose of remote irradiation, it is expedient to increase IORT doses, which is in turn fraught with higher incidence and severity of radiation lesions. In this connection, it seems urgent to have a look for the potentialities to expand the radiotherapeutical range. This follows several directions.

Adolescent↗