[Chemotherapy for esophageal cancer]

Esophageal cancer is supposed to be more sensitive to chemotherapy compared to other gastrointestinal cancers. Since cisplatin (CDDP) was developed, it has become a key drug for combined chemotherapy. At present, the combination of CDDP and 5-fluorouracil (5-FU) is the standard regimen for the treatment of esophageal carcinoma. Nedaplatin (CDGP) and paclitaxel (TXL) have shown favorable results either as a single agent or in combination with CDDP. Comparisons of drug efficacy between these new regimens and CDDP/5-FU in more cases has yet to be carried out. However, since esophageal cancer can hardly be cured by definitive chemotherapy alone, chemotherapy plays an important role in the multimodality therapy for esophageal cancer. The results of definitive chemoradiotherapy for advanced esophageal cancer has recently improved. The efficacy of preoperative (neoadjuvant) chemoradiotherapy in terms of survival benefit still remains controversial according to a meta-analysis of large-scale, randomized controlled trials (RCTs) when compared with surgery alone. A RCT completed by the Japan Clinical Oncology Group (JCOG) demonstrated the prognostic benefit of postoperative adjuvant chemotherapy for disease-free survival in comparison to surgery alone. Another RCT by JCOG has been conducted to clarify whether preoperative or postoperative chemotherapy may have a prognostic benefit in patients who undergo an esophagectomy.