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Positive nodal histology in the mediastinum or abdomen is the best available evidence of disseminated disease. Patients without such nodal involvement there-fore represent a group in whom the disease is most likely to be localized. It is suggested that only these patients be subjected to aggressive local therapy. The effects of no treatment, ortho- and megavoltage radiotherapy, surgery and combinations of surgery and radiotherapy are reviewed. The need for cooperative randomized clinical trials to test the biological hypothesis outlined is discussed. Megavoltage radiotherapy as a primary treatment for oesophageal cancer followed by radical surgery in those patients without evidence of dissemination from nodal histology is proposed as a basis for such clinical trials.<\/jats:p>","DOI":"10.1002\/bjs.1800671111","type":"journal-article","created":{"date-parts":[[2007,3,2]],"date-time":"2007-03-02T18:43:51Z","timestamp":1172861031000},"page":"791-797","source":"Crossref","is-referenced-by-count":18,"title":["Cancer of the oesophagus\u2014how should tumour biology affect treatment?"],"prefix":"10.1093","volume":"67","author":[{"given":"John G","family":"Roberts","sequence":"first","affiliation":[{"name":"Department of Surgery, Llandough Hospital , Penarth, South Glamorgan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[1980,11,1]]},"reference":[{"key":"2024092716192828800_bib1","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/S0140-6736(57)91944-X","article-title":"Carcinoma of the oesophagus, the case for surgical excision","volume":"2","author":"Collis","year":"1957","journal-title":"Lancet"},{"key":"2024092716192828800_bib2","doi-asserted-by":"crossref","first-page":"500","DOI":"10.2214\/ajr.105.3.500","article-title":"The value of radiotherapy in the management of oesophageal cancer","volume":"105","author":"Pearson","year":"1969","journal-title":"AJR"},{"key":"2024092716192828800_bib3","first-page":"227","article-title":"Cancer of the oesophagus: 1002 cases. 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