Preoperative (neoadjuvant) chemoradiotherapy in oesophageal cancer.
BACKGROUND
Oesophageal cancer carries a poor prognosis. The 5-year survival rate following resection ranges from 10 to 35 per cent. Recent evidence suggests that the addition of non-surgical treatments to surgery may improve resection rates, reduce the risk of recurrence and improve survival. This review examines the role of preoperative chemoradiotherapy (CRT) in oesophageal cancer.


METHODS
A Medline-based literature review (1980-2000) was performed using the key words 'neoadjuvant or preoperative' and 'chemoradiotherapy or radiochemotherapy'. Additional literature was obtained from original papers and published meeting abstracts.


RESULTS
Forty-six non-randomized and six randomized trials of preoperative CRT were found. Resection rates, pathological complete response (pCR), treatment-related mortality rates and relapse patterns are documented. Improved 5-year survival rates approaching 60 per cent may be achieved following pCR. Three of the six randomized trials show a benefit in either overall survival or disease-free survival compared with surgery alone. Treatment-related toxicity can be significant.


CONCLUSIONS
Preoperative CRT may improve survival. Emerging evidence suggests that CRT alone can achieve similar survival rates to surgery alone. New imaging modalities may help to select which patients require surgery. Larger randomized trials of preoperative CRT or chemotherapy are needed to define optimal regimens and produce higher pCR rates with acceptable toxicity.
Queen Elizabeth Hospital, Birmingham, Cookridge Hospital, Leeds and Mount Vernon Hospital, Northwood, UK.
J I
JI
Geh
A M
AM
Crellin
R
R
Glynne-Jones
D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D002986:Clinical Trials as Topic; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009364:Neoplasm Recurrence, Local; D011300:Preoperative Care / Q000379:methods; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D014055:Tomography, Emission-Computed / Q000379:methods