Neoadjuvant versus adjuvant treatment: which one is better for resectable esophageal squamous cell carcinoma?
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WORLD JOURNAL OF SURGICAL ONCOLOGY
REVIEW
Open Access
Neoadjuvant versus adjuvant treatment: which one is better for resectable esophageal squamous cell carcinoma? Yaping Xu1†, Xinmin Yu2†, Qixun Chen3† and Weimin Mao3*†
Abstract Esophageal cancer is the eighth most common cancer worldwide, and especially in some areas of China is the fourth most common cause of death and is of squamous cell carcinoma (SCC) histology in >90% of cases. Surgery alone was the mainstay of therapeutic intervention in the past, but high rates of local and systemic failure have prompted investigation into multidisciplinary management. In this review, we discuss the key issues raised by the recent availability of esophageal SCC treatment with the addition of chemotherapy, radiotherapy, and chemoradiotherapy to the surgical management of resectable disease and discuss how clinical trials and meta-analysis inform current clinical practice. None of the randomized trials that compared neoadjuvant radiotherapy or chemotherapy with surgery alone in esophageal SCC has demonstrated an increase in overall survival in those patients treated with neoadjuvant radiotherapy or chemotherapy. Neoadjuvant chemoradiotherapy has been accepted recently for esophageal cancer because such a regimen offers great opportunity for margin negative resection, improved loco-regional control and increased survival. The majority of the available evidence currently reveals that only selected locally advanced esophageal SCC are more likely to benefit from the adjuvant therapy. The focus of future trials should be on identification of the optimum regimen and should aim to minimize treatment toxicities and effect on quality of life, as well as attempt to identify and select those patients most likely to benefit from specific treatment options. Keywords: Esophageal cancer, Squamous cell carcinoma, Neoadjuvant therapy, Adjuvant therapy, Chemotherapy, Radiotherapy, Chemoradiotherapy
Review Introduction
Esophageal cancer is the most rapidly increasing tumor type in the world [1,2]. Globally, esophageal cancer is the eighth most common malignancy and sixth most fatal disease, with approximately 460,000 new diagnoses and > 380,000 deaths annually [3]. More than one-half of new cases in western countries have adenocarcinoma (AC) of the lower esophagus or gastroesophageal junction; and > 90% patients in eastern Asian countries have squamous cell carcinoma (SCC) [3,4].
* Correspondence: [email protected] † Equal contributors 3 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang, People’s Republic of China Full list of author information is available at the end of the article
Despite improvements in surgical and radiotherapy (RT) techniques and refinements of chemotherapeutic regimens, long-term survival, even from localized esophageal cancer, remains poor. Surgery alone was the mainstay of therapeutic intervention in the past, but high rates of local and systemic failure have prompted investigation into the multidisciplinary management. Trea
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