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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Ann+Cardiothorac+Surg
2017 ; 6
(2
): 167-174
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What is the role of neoadjuvant chemotherapy, radiation, and adjuvant treatment
in resectable esophageal cancer?
#MMPMID28447006
Altorki N
; Harrison S
Ann Cardiothorac Surg
2017[Mar]; 6
(2
): 167-174
PMID28447006
show ga
The majority of patients with operable esophageal cancers present with locally
advanced disease, for which surgical resection as a sole treatment modality has
been historically associated with poor survival. Even following radical
resection, most of these patients will eventually succumb to their disease due to
distant metastasis. For this reason, there has been intense interest in the role
of neoadjuvant therapy. Neoadjuvant therapy primarily consists of either
chemotherapy, radiation therapy, or a combination of the two. Multiple studies of
variable scope, design, and patient characteristics have been conducted to
determine whether neoadjuvant therapy is warranted, and-if so-what is the best
modality of treatment. Despite nearly three decades of study, decisions regarding
neoadjuvant therapy for esophageal cancer remain controversial. Regardless, the
available evidence provided by large, prospective studies supports preoperative
chemotherapy as opposed to surgery alone. Therefore, in our opinion, there is no
longer any question as to whether induction therapy is appropriate for locally
advanced esophageal cancer. Less clear, however, is the evidence that the
addition of radiation to chemotherapy in the preoperative setting is superior to
neoadjuvant chemotherapy alone. Our group generally advocates for neoadjuvant
chemotherapy alone followed by radical esophageal resection. The data for
adjuvant therapy are soft, and particularly troubling is the high rate of
treatment drop out in trials studying adjuvant therapy. Therefore, we strongly
prefer neoadjuvant chemotherapy and reserve adjuvant chemotherapy for those rare,
highly selected patients-patients with T1 tumors, for example-who do not receive
neoadjuvant treatment and are found to have occult nodal disease at the time of
surgery.
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