has been a swing over from mainly surgical to mainly radiation treatment associated with a rise in the overall one and five-year survival rates to 32% and 9% respectively. The main reason for failure is the prevalence of disseminated disease. The significant mortality of surgical treatment limits its usefulness. Too often, radiotherapy fails because of recurrence of tumor within the irradiated volume. In the upper 2/3 of the esophagus irradiation is preferable to surgery because of better survival. In the lower 1 /3 the two methods achieve similar long term survival but following irradiation the short term survival is better and the patient retains a normal stomach. Improvement could be achieved by prevention, earlier diagnosis, improved tumor delineation and a wide range of measures to improve the local effectiveness of irradiation.
Cancer 39:882-890, 1977.
SOPHAGEAL CANCER CONSTITUTES 1% OF ALL E cancer in North America and causes 2% of all deaths from cancer. Only 5% survive five years after diagnosis. The male : female ratio is 3 : 1. 21 Females have double the five year survival rate of males.15 There are parts of Russia, Africa, Asia and South America where it is the commonest of all cancers and in some of these areas the high incidence has arisen within living memory. le It is one of the most difficult cancers to cure, or even to palliate successfully. The typical esophageal cancer is a squamous carcinoma. Probably fewer than 5% are true primary adenocarcinomas and these usually oc-