However, an outstanding review article also provides new insight into the proper

interpretation of the mass of available data. Esophageal cancer management is particularly in need of such a skilled overview as there are many treatment options but little data to provide real clarity about the burdens and benefits of the options under individual clinical circumstances. Jabbour and Thomas are to be congratulated for not only compiling an enormous amount of data, but doing this in a refreshing way that Inhibitors,research,lifescience,medical provides insight into the proper management of esophageal cancer (1). The stated purpose of this review article is primarily to evaluate the data that applies to radiation therapy in the postoperative management of esophageal cancer. However, the authors comprehensively review the many potential roles of radiation therapy in definitive management of locally advanced esophageal cancer, whether given definitively, preoperatively, Inhibitors,research,lifescience,medical or postoperatively. The controversy Inhibitors,research,lifescience,medical about adjuvant and

neoadjuvant chemotherapy is addressed. This choice of a comprehensive review of the data contributed greatly to the value of this review article, allowing context to be placed on the data related to postoperative therapy, and in reality to provide a review more comprehensive than the goal implied by the title of the article. There Inhibitors,research,lifescience,medical are not well done definitive randomized trials to compare the outcome of postoperative therapy against preoperative therapy in esophageal cancer with modern staging and modern treatment techniques. In the United States preoperative therapy is commonly used in studies at major institutions in cooperative groups Inhibitors,research,lifescience,medical and this appears to have shaped routine clinical practice. The potential value of preoperative therapy is that adjuvant therapy could be started immediately targeting any micro metastatic deposits without allowing time for further growth, and treatment would not be given until diagnosis and staging is firmly PLX4032 assessed. In

addition, prior unless to surgery it is thought that the patient’ s may be better able to tolerate aggressive chemotherapy and radiation as it can start immediately and their physical and nutritional state has not been burden by the need to recover from surgery. On the other hand when therapy is given postoperatively full staging information is available and patients who have more extensive disease discovered at the time of surgery may be spared aggressive treatments and patients with earlier stage of disease than expected may also not require such treatment. The review article has several informative and important tables that provide an overview of the management of esophageal cancer. In particular, table 1 addresses preoperative versus postoperative therapy.