Preoperative chemotherapy for esophageal cancer – pro

Lay Summary: Chemotherapy or chemotherapy with radiation are standard of care for esophageal cancer that has not spread.

The role of preoperative chemoradiation for esophageal cancer is well established. Two meta-analyses comprised of the results from 15 randomized controlled trials, as well as pooling performed by the Gastrointestinal Cancer Disease Site Group, all detected a statistically significant difference in survival favouring preoperative chemoradiotherapy, but at three years only. Therefore, the Gastrointestinal Cancer Disease Site Group acknowledges there is evidence indicating survival benefits with either neoadjuvant chemotherapy or chemoradiotherapy compared with surgery alone; however, individual trial results are inconsistent. Based on the majority of the evidence available at this time, the Gastrointestinal Cancer Disease Site Group continues to support the stated recommendations and will continue to examine new evidence as it becomes available. NCCN does list chemoradiation for resectable esophageal cancer. It lists cisplatin/5FU or a “taxane based regimen” as acceptable alternatives. On p.18, NCCN notes that leukovorin is indicated in certain infusional 5FU regimens.

Malthaner RA, Collin S, Fenlon D. Preoperative chemotherapy for resectable thoracic esophageal cancer. Cochrane Database of Systematic Reviews 2001, Issue 1, esophageal cancer

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