NEOADJUVANT THERAPY FOR SQUAMOUS-CELL ESOPHAGEAL-CARCINOMA

A number of studies have demonstrated that preoperative chemotherapy ( CTx) and combination radiochemotherapy (RTx/CTx) in patients with pote ntially resectable and locally advanced squamous cell esophageal carci noma is feasible. In patients with potentially resectable tumors, neoa djuvant therapy followed by surgical resection has, however, so far no t shown an increase in the resection rate, rate of complete macroscopi c and microscopic tumor resections, i.e. RO-resections according to th e UICC, or survival time as compared to patients who had surgical rese ction alone. In this situation a survival benefit, if at all, can be e xpected only in those who respond to preoperative therapy. At the pres ent time preoperative CTx or RTx/CTx in patients with potentially rese ctable esophageal carcinoma must therefore be considered investigation al and should not be performed outside the context of clinical trials. In patients with locally advanced esophageal carcinoma, neoadjuvant t herapy markedly increases the rate of R0-resections and appears to pro long survival. Combined modality therapy in this context is, however, associated with a substantial perioperative mortality and morbidity. O pen questions that have to be addressed by randomized studies include the role, extent and timing of surgical resection in the combined moda lity approach to patients with locally advanced squamous cell esophage al carcinoma. Research has to focus on preoperative staging modalities and the development of more effective and less toxic preoperative the rapy regimen to improve identification of patients that might benefit from combined modality therapy and to more effectively combat systemic recurrences.