Neoadjuvant therapy for esophageal cancer

Abstract

Esophageal cancer is increasing in incidence more than any other visceral malignancy in North America. Adenocarcinoma has become the most common cell type. Surgery remains the primary treatment modality for locoregional disease. Overall survival with surgery alone has been dismal, with metastatic disease the primary mode of treatment failure after an R0 surgical resection. Cure rates with chemotherapy or radiation therapy alone have been disappointing as well. For these reasons, over the last decade multi-modality treatment has gained increasing acceptance as the standard of care. This review examines the present data and role of neoadjuvant treatment using chemotherapy and radiation therapy followed by surgery for the treatment of esophageal cancer.

Keywords: Neoadjuvant therapy, Esophageal cancer, Esophagectomy, Chemotherapy

Core tip: This review evaluates the current literature on the use of neoadjuvant chemotherapy with or without radiation therapy for the treatment of locally advanced esophageal cancer. Major randomized controlled trials and co-operative group studies have been evaluated. Response rates, survival, complete response and outcomes have been thoroughly reviewed.