title: Perioperative therapy for esophageal cancer.
abstract: Traditionally, surgery is considered the best treatment for esophageal cancer in terms of locoregional control and long-term survival, but survival after surgery alone for locally advanced esophageal cancer is not satisfactory. A multidisciplinary approach that includes surgery, radiotherapy, and chemotherapy, alone or in combination, has been developed to improve the prognosis. Multiple clinical trials have addressed the preferred treatment strategy, such as neoadjuvant or adjuvant and chemotherapy, radiotherapy, or chemoradiotherapy, in managing locally advanced esophageal cancer. In this review, we provide an update on treatment strategies for locally advanced esophageal cancers. Recent studies indicate that neoadjuvant chemoradiotherapy or chemotherapy has a survival benefit over surgery alone in this patient group. Neoadjuvant chemoradiotherapy is an accepted standard of care in the United States while neoadjuvant chemotherapy is regarded as standard treatment in Japan and the United Kingdom. The standard treatment differs among countries because two large randomized controlled trials that evaluated the effectiveness of neoadjuvant chemotherapy reported conflicting results and no trial has made a comparison between neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy directly. Future trials in locally advanced esophageal cancer should focus on identifying the optimum strategy and its regimen and aim to minimize treatment toxicities and effects on quality of life.
authors: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0879, Japan, myamasaki@gesurg.med.osaka-u.ac.jp.
authors: Makoto
authors: M
authors: Yamasaki
authors: Hiroshi
authors: H
authors: Miyata
authors: Yasuhiro
authors: Y
authors: Miyazaki
authors: Tsuyoshi
authors: T
authors: Takahashi
authors: Yukinori
authors: Y
authors: Kurokawa
authors: Kiyokazu
authors: K
authors: Nakajima
authors: Shuji
authors: S
authors: Takiguchi
authors: Masaki
authors: M
authors: Mori
authors: Yuichiro
authors: Y
authors: Doki
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy; D006801:Humans; D007564:Japan; D020360:Neoadjuvant Therapy; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom; D014481:United States