Role of chemoradiotherapy in oesophageal cancer -- adjuvant and neoadjuvant therapy

Despite low postoperative mortality rates, the long-term outcomes from surgical-based treatment for oesophageal cancer remain poor. Chemoradiotherapy (CRT), either given before surgical resection as neoadjuvant therapy or after resection as adjuvant therapy, has been postulated to improve these outcomes. This systematic review examines the evidence for these approaches. The evidence for postoperative radiotherapy is limited and conclusions are difficult, but it may have a role in patients at high risk of local relapse (positive margins). The addition of chemotherapy is recommended when possible. Patient selection is important due to the associated toxicities. The evidence for neoadjuvant treatment is stronger and based on the current evidence neoadjuvant CRT can be recommended as a treatment approach in T2-T4, N1-3 oesophageal cancer for both adenocarcinoma and squamous cell carcinoma, but further work is needed to establish its superiority over neoadjuvant chemotherapy alone, particularly for adenocarcinoma. We recommend that further studies divide the two histologies and they should be treated as two separate diseases.