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Neoadjuvant therapy for squamous cell esophageal carcinoma
U Fink1, H J Stein, H Bochtler
1Department of Surgery, Technische Universität München, Germany.
Summary
Preoperative chemotherapy for resectable esophageal cancer is investigational. For locally advanced cases, neoadjuvant therapy improves R0-resections and survival but carries high perioperative risks.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Preoperative chemotherapy (CTx) and radiochemotherapy (RTx/CTx) are feasible for esophageal carcinoma.
- Neoadjuvant therapy in potentially resectable tumors has not improved resection rates or survival compared to surgery alone.
Purpose of the Study:
- To evaluate the efficacy and safety of neoadjuvant therapies in esophageal cancer.
- To identify patient subgroups that may benefit from preoperative treatment.
Main Methods:
- Review of studies on neoadjuvant CTx and RTx/CTx for squamous cell esophageal carcinoma.
- Analysis of outcomes including resection rates (R0-resections) and survival.
Main Results:
- Neoadjuvant therapy did not increase resection rates or survival in potentially resectable esophageal cancer.
- For locally advanced disease, neoadjuvant therapy significantly increased R0-resections and survival.
- Combined modality therapy for locally advanced disease is associated with substantial perioperative mortality and morbidity.
Conclusions:
- Preoperative CTx or RTx/CTx for potentially resectable esophageal cancer should be considered investigational.
- Neoadjuvant therapy offers benefits for locally advanced esophageal cancer but requires careful management of perioperative risks.
- Further research is needed on preoperative staging, optimizing therapy regimens, and defining the role of surgery in combined modality treatment.