Dr. Anton Titov, MD. What is the role of radiosurgery in the treatment of esophageal cancer? Where does it fit in the process of chemotherapy, neoadjuvant chemotherapy, and surgery? Well, there are different opinions on that. Dr. Jari Rasanen, MD. Dr. Anton Titov, MD. What is the optimal neoadjuvant treatment for adenocarcinoma of esophagus? A so-called cross-trial done by a Dutch group proves that the patient will get significant benefit from the neoadjuvant chemoradiation. On the other hand, there are then mostly British studies, which show that you can get the same benefit by giving the patients with esophageal carcinoma Neoadjuvant chemotherapy only. In Western countries, everybody agrees that if the patient has squamous cell esophageal carcinoma, the best possible neoadjuvant treatment is chemoradiation. In the Eastern countries, like in Japan, they think that the best neoadjuvant treatment for squamous cell carcinoma is chemotherapy only. So, there is a lot of disagreement about the optimal treatment. Dr. Jari Rasanen, MD. Still, in Western countries everybody agrees that you need to give chemoradiation upfront in squamous cell esophageal carcinoma. The importance of radiation in all other cases of esophageal cancer is very controversial. For the Western-type adenocarcinoma of the esophagus radiotherapy is not typically given? Esophageal cancer radiotherapy approach depends whether you believe in Dutch studies or whether you believe in a study coming from the UK. So, there are certainly groups who are giving chemoradiation to adenocarcinoma as neoadjuvant treatment. On the other hand, there are a lot of groups who are giving only chemotherapy. In our institution, we believe more in previous studies. So it means that our policy is to give chemotherapy only for esophageal adenocarcinoma and chemoradiation for squamous cell carcinoma of the esophagus.