Neoadjuvant therapy of squamous cell carcinoma of the esophagus

Because of the high risk of recurrence following surgery for squamous cell carcinomas of the esophagus, treatment involving both systemic therapy and a localized approach [either surgery alone or chemo/radiation and surgery] have been extensively studied. Pilot trials have demonstrated safety for the use of chemotherapy followed by operation, or for chemotherapy plus standard radiation plus surgery. Larger scale phase III trials, in which either of these two strategies is employed, have now been reported. For chemotherapy followed by surgery, conflicting results have recently been noted. A US intergroup trial showed no significant outcome for all patients treated. A smaller European study, also using a cisplatin-based regimen, had a positive result. Similarly, for chemoradiation followed by operation, two recent random assignment studies failed to demonstrate a significant difference in outcome. However, recently newer chemotherapy agents have been identified which hold promise for more effective therapy. These include paclitaxel and irinotecan. Phase II trials, using these agents prior to surgery, are underway or have been completed, and phase III studies are in the advanced planning stage. Until these trials have demonstrated superiority, surgery alone or chemoradiation without surgery remain the standard of care, for patients with esophageal cancer.