Despite all advances, treatment of esophageal carcinoma is still unsatisfactory. Currently the standard non-surgical treatment of esophageal cancer is concurrent chemotherapy and radiotherapy (chemoradiation), with results comparable to best surgical series. A few years ago, we started a chemoradiation protocol for the cancer of esophagus as a curative treatment, of which we present the preliminary results here. Files of all esophageal carcinoma patients treated in our department since 1996 until mid 2001 were checked, and those treated by chemoradiation were selected and reviewed. Overall survival was measured from the start of radiotherapy to the time of last follow-up or death. Results were compared to historical controls treated by radiotherapy alone in our department, reviewed in a recent study. Twenty-eight patients (17 males and 11 females, mean age 59 years, tumor location in the middle-third of esophagus in 54%, all squamous carcinoma except one adenocarcinoma) were treated by two courses of cisplatin and 5-FU chemotherapy with concurrent radiotherapy. Radiation dose was mostly 50 Gy in 25 fractions. Mean overall survival was 17 months and median survival was not reached yet due to relatively short follow-up. Compared to 283 patients treated by radiotherapy alone with a mean and median survival of 12 and 8 months, chemoradiation was significantly superior (P=0.0004). Concurrent chemoradiation as used in our department offers a definitely better chance of survival compared to radiotherapy alone. To improve the results, we are pursuing the combination of neoadjuvant chemoradiation and surgery in a clinical trial

Chemicals are health hazards, under specific sets of conditions transforming into a potential “ risk” . In the story of creation and the Garden of Eden, a poisonous fruit was a hazard, but malicious intervention of the serpent convincing Eve and Adam to eat the poisonous fruit was the risk. A very simple model is: Hazard  Exposure  Risk In recent decades, regulatory measures that limit exposures to harmful chemicals have protected the population from the risks of chemicals. Use of leaded gas, for example, was banned beginning in the 1970's leading to a drastic decrease in the risk of exposure at the population level. It is generally accepted that when there is no exposure, exposure is below the regulatory limits or if we are not aware of toxic exposures, risks related to contacts to chemicals are negligible. . .