[Place of neoadjuvant treatments in oesophageal cancers care]

Esophageal cancer has a poor prognosis. Recent epidemiological data has shown a modification of histologic types, as adenocarcinoma represents more than 50% of all patients newly diagnosed. Despite progress of surgery, overall survival at 5 years is still about 20% for resectable tumors, supporting the need for additional therapies. Objectives for neoadjuvant treatments are to increase the rate of resectability R0, to decrease the rate of local failure, to treat precociously the micrometastatic disease especially since adjuvant therapies were inefficient or inapplicable. This work is a review of main data from the literature about preoperative treatments : radiotherapy, chemotherapy and chemoradiotherapy for both adenocarcinoma and squamous cell cancers. New therapeutic strategies are arising in order to optimize these results including new drugs as irinotecan, taxans and targeted therapies. Moreover it is necessary to question the place of surgery in locally advanced but resectable tumors.