Preoperative or postoperative therapy for resectable oesophageal cancer: an updated practice guideline

Oesophageal cancer is an aggressive disease and the optimal therapy for patients with resectable tumours remains unclear. A systematic review and companion practice guideline were published in 2004; however, new evidence has become available since the publication of the original report. An update of the literature search and a revision of the recommendations were undertaken to incorporate the new data. The following research question was addressed: should patients with resectable oesophageal cancer receive preoperative or postoperative therapy together with surgery? The outcomes of interest were survival, adverse effects and quality of life.

The literature search of the original systematic review was updated to April 2007. MEDLINE, EMBASE, Cochrane Library and abstracts from the American Society of Clinical Oncology and the American Society for Therapeutic Radiology and Oncology were searched for reports of randomised controlled trials and meta-analyses comparing preoperative or postoperative therapy with surgery alone or other preoperative or postoperative therapy. After the completion of the draft systematic review and practice guideline, the report was distributed through a mailed survey to 133 health care providers in Ontario for review and feedback.

The updated literature search yielded eight new randomised controlled trial reports and seven new meta-analysis reports for consideration, together with the evidence reviewed in the original review publication. Of the 31 practitioners who responded to the mailed survey, 80% agreed with the draft recommendations as stated, 83% agreed that the report should be approved as a practice guideline and 86% indicated that they would probably use the guideline in their own practice.

Preoperative cisplatin-based chemotherapy plus radiotherapy is recommended as the preferred modality for the management of surgically resectable patients with oesophageal cancer. Preoperative cisplatin-based chemotherapy alone is an alternative choice for the management of these patients.