title: Neoadjuvant or adjuvant therapy for resectable esophageal cancer: is there a standard of care?
abstract: BACKGROUND
  Carcinoma of the esophagus is an aggressive and lethal disease with an increasing incidence worldwide. Despite changes in the treatment approach over the past two decades and even following complete resection, most patients will eventually relapse and die as a result of their disease. Several clinical trials evaluated different modalities in treating locally advanced esophageal cancer; however, because of stage migration and the changes in disease epidemiology, applying these trials to clinical practice has become a daunting task.
  
  
  METHODS
  We searched Medline and conference abstracts for randomized studies published in the past three decades. We restricted our search to articles published in English.
  
  
  RESULTS
  Neoadjuvant chemoradiotherapy followed by surgical resection is an accepted standard of care in the United States for patients with locally advanced esophageal cancer. Esophagectomy remains an essential component of treatment and can lead to improved overall survival, especially when performed at high-volume institutions. The role of adjuvant chemotherapy following curative resection in patients who underwent neoadjuvant chemotherapy and radiation remains unclear.
  
  
  CONCLUSIONS
  Several questions still need to be answered regarding the use of neoadjuvant or adjuvant therapy for patients with resectable esophageal cancer. The optimal chemotherapy regimen has not yet been identified for these patients, although newer therapies show promise.
authors.affiliation: Gastrointestinal Tumor Program, H Lee Moffitt Cancer Center, Tampa, FL 33612, USA. Khaldoun.Almhanna@Moffitt.org
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Almhanna
authors.forename: Ravi
authors.initials: R
authors.lastname: Shridhar
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Meredith
mesh_terms: D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy / Q000379:methods / Q000592:standards; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D006801:Humans; D020360:Neoadjuvant Therapy; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic