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The role of preoperative chemotherapy for esophageal cancer: when is surgery alone feasible?

Nature Clinical Practice Oncology volume 2, pages 172–173 (2005)Cite this article

There is continuing controversy regarding the role of chemotherapy in the management of localized esophageal cancer. Preoperative chemotherapy is a strategy that has the potential to improve patient outcome by increasing the probability of complete surgical resection and/or early treatment of metastatic disease. Despite two relatively large randomized trials and three meta-analyses, international consensus in this area has not been reached.

The North American Intergroup Trial 0113 randomized 440 patients with esophageal adenocarcinoma (54%) and squamous cell carcinoma (46%) to preoperative chemotherapy plus surgery or to surgery alone.1 Patients in the chemotherapy arm received three cycles of preoperative cisplatin and 5-fluorouracil (5-FU), as well as two cycles of postoperative chemotherapy if they had stable or responsive preoperative disease. Of note, only 38% of patients completed all five cycles of perioperative chemotherapy. There was a higher probability of microscopic involvement of the resection margin (R1 resection) in the surgery-alone arm compared with the perioperative chemotherapy arm (15% versus 4%; P = 0.0001). However, there was no difference in median survival between the chemotherapy plus surgery and surgery-alone arms (14.9 months versus 16.1 months; P = 0.53). Postoperative complication rates were similar for both arms. The lack of survival benefit in this trial has clearly influenced clinical practice in the US, where preoperative chemotherapy is not routinely used for patients with localized esophageal cancer.2 Although randomized comparisons of preoperative chemotherapy and chemoradiation have not been performed, preoperative chemoradiation is generally considered to be standard practice in North America.

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Authors and Affiliations

  1. medical oncologist at the Royal Marsden Hospital, London, UK

    Geoff Chong

  2. Professor and Head of the Gastrointestinal Cancer Unit at the Royal Marsden Hospital, London, UK

    David Cunningham

Authors
  1. Geoff Chong
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  2. David Cunningham
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Correspondence to David Cunningham.

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The authors declare no competing financial interests.

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Chong, G., Cunningham, D. The role of preoperative chemotherapy for esophageal cancer: when is surgery alone feasible?. Nat Rev Clin Oncol 2, 172–173 (2005). https://doi.org/10.1038/ncponc0126

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