[Neoadjuvant therapy for squamous cell carcinoma of the esophagus].
Neoadjuvant treatment for locally advanced squamous cell carcinoma of the esophagus is widely used, despite minimal evidence of its efficacy. With only a minor effect on survival, the benefits of neoadjuvant radiotherapy alone appear to be limited. The same is true for neoadjuvant chemotherapy alone. While no single randomized study has shown a statistically significant result favoring neoadjuvant chemoradiation vs no treatment, the results of three meta-analyses indicate a prognostic benefit. Unfortunately, earlier chemoradiation protocols were associated with considerable side effects and contributed to perioperative morbidity and mortality. In contrast, modern chemoradiation protocols were revealed to be feasible when carried out in experienced institutions. Therefore, neoadjuvant chemoradiation is indicated in locally advanced stages. Patients should be referred to specialized centers for initial treatment planning and resection, and they should be enrolled in clinical studies whenever possible.
Lordick
F
F
Interdisziplinäres Tumortherapiezentrum am Klinikum rechts der Isar, Technische Universität München. f.lordick@lrz.tu-muenchen.de
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D016629:Esophagectomy; D004947:Esophagus / Q000473:pathology; D019317:Evidence-Based Medicine; D006801:Humans; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage