Multidisciplinary Management of Esophageal Cancer.

Abstract

Esophageal cancer (EC) is a highly lethal malignancy with geographic, histologic, and biologic heterogeneity. Advances in endoscopic therapy, multimodality treatment, biomarker-driven systemic therapy, and supportive care have reshaped contemporary management. This review summarizes current approaches to diagnosis, staging, and treatment of EC, with emphasis on stage-, histology-, and biomarker-directed decision making within a multidisciplinary framework. This is a narrative review of clinical guidelines, landmark trials, and recent evidence informing the management of esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) across disease stages, including evolving systemic therapies and supportive care strategies. Early-stage EC is increasingly managed with endoscopic resection and ablative therapies, enabling esophageal preservation in carefully selected patients. Locally advanced disease requires multimodality treatment tailored by resectability and histology. Neoadjuvant chemoradiation followed by surgery remains a standard approach for resectable ESCC, whereas perioperative systemic therapy is favored for many patients with EAC due to its higher risk of early distant dissemination. Adjuvant immunotherapy improves disease-free survival in patients with residual disease after neoadjuvant chemoradiation and resection. In unresectable or metastatic EC, biomarker-driven strategies incorporating immune checkpoint inhibitors and targeted agents have improved outcomes compared with chemotherapy alone. Supportive care interventions addressing nutrition, symptom control, and psychosocial needs are essential throughout the disease course. Optimal management of EC requires individualized, multidisciplinary care integrating tumor stage, histology, molecular characteristics, and patient fitness. Continued advances in systemic therapy, immunotherapy, and supportive care are refining treatment paradigms with the goal of improving survival while preserving quality of life.