Multidisciplinary approach for patients with esophageal cancer

Table 1 Randomized trials of neoadjuvant radiation in esophageal cancer

Ref.	Histology	n	Rad dose (Gy)	2-yr survival, %	5-yr survival, %
Launois et al[18]	SCC	57	-	11.5	NR
		67	39-45	9/5	NR
Gignoux et al[17]	SCC	106	-	10	9
		102	33/12	16	10
Wang et al[20]	NR	102	-	33	30
		104	40	37	35
Nygaard et al[19]	SCC	50	-	NR	9 (3 yr)
		58	35 (4 wk)	NR	21 (3 yr)
Arnott et al[16]	SCC	86	-	NR	17
	AC	90	20 (10 d)	NR	9

SCC: Squamous cell carcinoma; NR: Not reported; AC: Adenocarcinoma.

Table 2 Randomized trials of peri-operative chemotherapy in gastric and esophageal cancer

Ref.	Histology	Regimen	n	Resection	pCR	5-yr survival %	P value	Median survival (mo)
Kelson et al[23]	SCC (45%)	S	227	59%	NA	23 (3 yr)	NS	16.1
	AC (55%)	CF→S→CF	213	62%	2.50%	26 (3 yr)		14.9
Cunningham et al[22]	AC - Gastric	S	253	66%	NA	23	0.009	20
	25% GEJ	ECF→S→ECF	250	69%	0%	36		24
MRC et al[24]	SCC (35%)	S	402	54%	NA	17	0.004	13.3
	AC (65%)	CF→S	400	62%	NA	23		16.8
Roth et al[25]	AC/SCC	S	20	NR	NR	5	NS	9
		BVC→S	19			25		9
Ychou et al[26]	AC
	75% GEJ	S	111	111	NA	24	0.02	NR
	25% Gastric	CF→S→(CF)	113	113	NR	38		NR

CF: Cisplatin and 5-fluorouracil; SCC: Squamous cell carcinoma; ECF: Epirubicin, cisplatin and 5-fluorouracil; AC: Adenocarcinoma; NA: Not Applicable; GEF: Gastroesphageal junction/distal esophagus; NR: Not recorded; NS: Not significant; S: Surgery; BVC: Bleomycin, vindesine, cisplatin; pCR: Protein catabolic rate; GEJ: Gastroesophageal junction.

Table 3 Randomized trials of neoadjuvant combined modality therapy for esophageal cancer

Ref.	Cell type	n	Total dose (Gy)	5-yr survival, %	Median survival (mo)	P value	Criticism
Nygaard et al[19]	SCC	47	BP + 35 + surg	11.5 (3 yr)	8	NS	Unconventional chemotherapy and low dose RT
		41	Surgery	9.5 (3 yr)	7
Bosset et al[34]	SCC	143	P + 37 + surg		19	NS	Split course RT and unconventional chemo schedule
		139	Surgery	9	19
Tepper et al[61]	SCC (25%)	30	PF + 50.4 + surg	39	54	< 0.001	Only 56 of 475 planned patients entered
	AC (75%)	26	Surgery	16	21
Walsh et al[62]	AC (100%)	58	PF + 40 + surg	32 (3 yr)	16	< 0.05	Only 6% 5 yr survival benefit with surgery alone
		55	Surgery	6 (3 yr)	11
Gaast et al[63]	SCC (25%)	175	Carbo/tax + 41 + surg	59 (3 yr)	49	< 0.001	Only 41 Gy RT
	AC (75%)	188	Surgery	48 (3 yr)	26
Le Prise et al[85]	SCC	41	PF + 20 (split) + surg	19 (3 yr)	10	NS	Only some patients received split course radiotherapy
		45	Surgery	14 (3 yr)	10		chemotherapy
Apinop et al[86]	SCC	35	PF + 20 + surg	24	10	NS	Low dose RT
		34	Surgery	10	7
Lee et al[87]	SCC	51	PF + 45.6 (bid) +surg	49 (3 yr)	28	NS	1.2 Gy bid radiation
		50	Surgery	51 (3 yr)	27
Urba et al[88]	SCC (25%)	47	PF + 45 +surg	30 (3 yr)	17	NS	15% survival benefit but not statistically significant
	AC (75%)	50	Surgery	16 (3 yr)	18
Burmeister et al[89]	SCC (37%)	128	PF + 35 + surg	17	22	NS	Only 35 by radiation delivered
	AC (62%)	128	Surgery	13	19
Mariette et al[90]		97	PF + 45 + surg	NR	32	0.66	TI-2 only, Hi postoperative mortality c CRT
		98	Surgery		44

P: Cisplatin; BP: Bleomycin and cisplatin; NS: Not significant; PF: Cisplatin and 5-fluorouracil; AC: Adenocarcinoma; SCC: Squamous cell carcinoma; NR: Not reported; NS: Not significant; RT: Radiation; CRT: Chemoradiotherapy.