Adjuvant chemoradiation for esophageal cancer – pro
Carcinoma of the esophagus is an aggressive malignancy with an increasing incidence. Its virulence, in terms of symptoms and mortality, justifies a continued search for optimal therapy. A recent clincial guidelines concluded: ” In consideration of the systematic review, external review, and subsequent Practice Guidelines Coordinating Committee revision suggestions, and final approval, the Gastrointestinal Cancer Disease Site Group recommends the following:For adult patients with resectable thoracic esophageal cancer for whom surgery is considered appropriate, surgery alone (i.e., without neoadjuvant or adjuvant therapy) is recommended as the standard practice.” This is also the conclusion of the Ontario Evidence Based Program based on the same evidence, except that it accepts preoperative chemotherapy but not adjuvant postop therapy.
Other guidelines disagree. NCCN recommends fluorpyrimidine based chemo radiation for T2 and T3, N0 or node positive disease. It defines it as 5FU or capecitabine, without leukovorin and also recommends pre and postoperative ECF.
Malthaner RA, Wong RK, Rumble RB, Zuraw L; Gastrointestinal Cancer Disease Site Group of Cancer Care Ontario’s Program in Evidence-based Care. Neoadjuvant or adjuvant therapy for resectable esophageal cancer: a clinical practice guideline. BMC Cancer. 2004 Sep 24;4:67.
Malthaner RA, Wong RK, Rumble RB, Zuraw L; Members of the Gastrointestinal Cancer Disease Site Group of Cancer Care Ontario’s Program in Evidence-based Care. Neoadjuvant or adjuvant therapy for resectable esophageal cancer: a systematic review and meta-analysis.BMC Med. 2004 Sep 24;2:35.
http://www.cancercare.on.ca/pdf/pebc2-11f.pdf
NCCN.Esophageal
Cascinu S, Labianca R, Barone C, et al. Adjuvant treatment of high-risk, radically resected gastric cancer patients with 5-fluorouracil, leucovorin, cisplatin, and epidoxorubicin in a randomized controlled trial. J Natl Cancer Inst 2007; 99:601.
Sun P, Xiang JB, Chen ZY. Meta-analysis of adjuvant chemotherapy after radical surgery for advanced gastric cancer. Br J Surg 2009; 96:26.