Preoperative chemotherapy versus surgical therapy alone for squamous cell carcinoma of the esophagus: A prospective randomized trial

Abstract

Preoperative chemotherapy was safe and resulted in significant downstaging and an increased likelihood of curative resection. Survival was not better than that in the surgery-alone group, but responders did fare better than nonresponders.

Positron emission tomography for monitoring response to neoadjuvant therapy in patients with oesophageal and gastro-oesophageal junction carcinoma

“…Several studies looking at neoadjuvant and palliative chemotherapy reported that those patients who responded to treatment had an improved survival outcome [4][5][6][7][8][9] with neo-adjuvant regimens having a response rate, at best, of 50-60% [1]. Studies clearly demonstrate that those who do not respond to neoadjuvant chemotherapy have a significantly worse prognosis than those who have surgery alone [4,5,7].…”

“…Studies clearly demonstrate that those who do not respond to neoadjuvant chemotherapy have a significantly worse prognosis than those who have surgery alone [4,5,7]. If outcome is to be maximised in patients likely to derive benefits from neoadjuvant therapy while at the same time ensuring others are not subjected to potentially harmful and ineffectual treatment, an early means of differentiating responders from non responders is required.…”

Detection of interval distant metastases

“…1 Esophagectomy is the treatment of choice in patients with early-stage disease. In patients with more advanced stage disease, the role of neoadjuvant therapy before esophagectomy is evolving, [2][3][4][5][6][7] with most studies showing no benefit over surgery alone. 6,7 However, there is evidence to suggest that the subset of patients who have a pathological response to neoadjuvant therapy will have improved survival after surgery compared with those patients who undergo esophagectomy alone.…”

“…In patients with more advanced stage disease, the role of neoadjuvant therapy before esophagectomy is evolving, [2][3][4][5][6][7] with most studies showing no benefit over surgery alone. 6,7 However, there is evidence to suggest that the subset of patients who have a pathological response to neoadjuvant therapy will have improved survival after surgery compared with those patients who undergo esophagectomy alone. 5,6,[8][9][10][11] Conversely, patients who do not have a pathological response to neoadjuvant therapy have a worse prognosis after subsequent esophagectomy than those patients who are resected de novo.…”

“…5,6,[8][9][10][11] Conversely, patients who do not have a pathological response to neoadjuvant therapy have a worse prognosis after subsequent esophagectomy than those patients who are resected de novo. 6,7,11 In the context of making clinical decisions with regard to those patients who are most likely to benefit from esophagectomy after multimodality therapy, the determination of the pathological response to neoadjuvant therapy is both clinically difficult and important. Recently, it has been proposed that 2-fluoro-2-deoxy-dglucose (FDG) positron emission tomography (FDG-PET) imaging can identify those patients who have had a response to neoadjuvant therapy and who will benefit from subsequent esophagectomy.…”