Researchers from the UK have reported that neoadjuvant chemotherapy improves five-year survival from 17.1% to 23.0% in patients with resectable esophageal cancer. The details of this study appeared in the October 20, 2009 issue of the Journal of Clinical Oncology.[1]

Standard treatment for localized and locally advanced esophageal cancer includes surgery (if possible), chemotherapy, and radiation therapy. Neoadjuvant chemotherapy and radiation therapy are often used to reduce the size of the cancer prior to surgery. A meta-analysis was conducted of 10 randomized trials comparing neoadjuvant chemoradiotherapy or chemotherapy to surgery alone in almost 3,000 patients with local, operable esophageal carcinoma. Chemoradiotherapy was associated with a 19% reduction in overall mortality with a two-year survival improvement of 13%. Neoadjuvant chemotherapy was associated with a 10% reduction in overall mortality with a two-year survival improvement of 7%. However, there have been few reports of the long-term effects of neoadjuvant chemotherapy and radiotherapy in patients with resectable esophageal cancer.

Researchers affiliated with Medical Research Council clinical trial OEO2 have now reported a six-year follow-up of a study initially published in 2002.[2] This trial randomly allocated 802 previously untreated patients with resectable esophageal cancer to receive surgery alone or preoperative chemotherapy followed by surgery. Chemotherapy consisted of two cycles of treatment with 5-FU and Platinol® (cisplatin). At the time of initial publication, the two-year survival rates were 43% for the neoadjuvant group and 34% for the surgery-alone group. With a median follow-up of six years, the five-year survival is 23% for the neoadjuvant group and 17.1% for the surgery-alone group. This represents a 16% reduction in mortality. Chemotherapy was equally effective for adenocarcinoma and squamous cell carcinoma. Patients with incomplete or no surgical resection benefited the most from neoadjuvant chemotherapy, but the best survival—42.4%—occurred in patients with complete surgical resection. These authors suggest that “preoperative chemotherapy improves survival in operable [esophageal] cancer and should be considered the standard of care.”

Comments: There is still some confusion about the relative roles of neoadjuvant chemotherapy and radiotherapy for treatment of operable esophageal cancer.

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