Guidelines for diagnosis and treatment in Japan

Guidelines for diagnosis and treatment of carcinoma of the esophagus were developed to provide recommendations concerning standard treatments for carcinoma of the esophagus, facilitating the daily clinical practice of esophageal carcinoma management (The Japan Esophageal Society, Guidelines for diagnosis and treatments of esophageal cancer, Kanehara Co. Ltd.: Tokyo, 2012). The third edition of guidelines was published in 2012, covering not only therapeutic issues but also diagnostic aspects. English version of the 3rd edition of guidelines is now under preparation. This chapter was described by summarized and modified the contents of draft version of the 3rd edition of guidelines. Comprehensive evaluation of clinical stage and general condition of the patients are critically important because therapeutic strategies are often greatly influenced by patient-specific factors. There is a significant difference of common histological types of esophageal carcinoma between the East and the West. Therefore, Japanese oncologists could not directly introduce guidelines recommended by western countries based on evidence from clinical studies including adenocarcinoma with different clinicopathological factors. Although multimodal treatment is now mainstay as a therapeutic strategy for esophageal carcinoma in the whole world, a role and survival impact of surgical treatment among multimodal approach is more obvious and significant in Japan. In the 2012 edition of guidelines, preoperative neoadjuvant chemotherapy with cisplatin and 5-FU is recommended as a standard treatment for resectable stage II or III thoracic esophageal carcinoma (2002 UICC classification) based on the results of randomized controlled trial (RCT) conducted by Japan Clinical Oncology Group (JCOG) which is the largest and the most reliable cooperative study group in Japan. On the other hand, neoadjuvant chemoradiation is the standard approach in the West. As summarized in this chapter, the 2012 edition of guidelines has covered wide range of clinical issues in the management of esophageal carcinoma comprehensively. Utilizing accumulated knowledge in the 2012 edition, we should pay attention to make more clear and concise message for users of the guidelines in the future.