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Consequently, additional research must focus on parameters that facilitate the identification of patients who might benefit from neoadjuvant therapy and that improve the assessment of response prior to resection. Potential markers that are currently under investigation include the endoscopic growth pattern of the tumor and several subcellular and molecular markers of the tumor cells.

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Positron emission tomography is currently also under investigation as a tool for assessing response to neoadjuvant therapy. The potentially increased risk of esophageal resection after neoadjuvant therapy has prompted several investigators to question the role of surgical resection after chemotherapy or radiochemotherapy. Several recent studies show that in contrast to patients who had neoadjuvant therapy followed by resection, patients who have radiochemotherapy alone commonly exhibit local tumor recurrences [ 48 , 49 ].

Surgical resection therefore remains an essential component of the combined-modality approach to treating esophageal cancer. However, at the present time it is unclear whether a surgical resection should be performed on all patients receiving neoadjuvant therapy or only on those who respond to neoadjuvant therapy.

Table of contents

The optimal timing of surgical resection, i. Furthermore, the extent of resection and lymphadenectomy after neoadjuvant therapy remains controversial. In order to definitely answer these questions, carefully designed further-randomized prospective trials are essential. User Name Password Sign In. Multimodality Therapy for Esophageal Cancer J. Siewert , H. Stein and U. Telephone: ; Fax: Accepted May 20, Previous Section Next Section. Figure 1. Preoperative Radiotherapy The use of neoadjuvant radiation is based on the premise of preoperative devitalization, reduction of the tumor bulk and eradication of lymph node metastases.

View this table: In this window In a new window. Table 1. Preoperative Chemotherapy At least theoretically, the preoperative use of chemotherapy offers several advantages. Table 2. Preoperative Combined Radiochemotherapy The low rate of complete pathological responses with preoperative chemotherapy alone prompted several groups to assess a combination of preoperative chemotherapy with radiation. Figure 2. Figure 3. Patient Selection for Neoadjuvant Therapy Based on this analysis, the choice of therapy for esophageal cancer should be guided by the resectability of the tumor and the physiological status of the patient [ 13 , 45 ].

Selection of the Neoadjuvant Therapeutic Modality Careful long-term follow-up of patients who had neoadjuvant therapy followed by surgical resection shows that control of distant disease remains a major problem. Assessment of Response to Neoadjuvant Therapy Most available studies show that a prognostic benefit from multimodal therapy can be expected only in patients who respond to preoperative therapy and who have a subsequent complete tumor resection.

Role and Extent of Surgical Resection after Neoadjuvant Therapy The potentially increased risk of esophageal resection after neoadjuvant therapy has prompted several investigators to question the role of surgical resection after chemotherapy or radiochemotherapy. Previous Section. Ratio of invaded to removed lymph nodes as a predictor of survival in squamous cell carcinoma of the oesophagus. Br J Surg ; 81 : — Medline Google Scholar. Prognostic factors of resected adenocarcinoma of the esophagus.

Surgery ; : — CrossRef Medline Google Scholar. Surgical therapy of esophageal cancer: preoperative risk analysis and mortality. Br J Surg in press. Google Scholar. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg ; : — Superiority of extended en bloc esophagogastrectomy for cancer of the lower esophagus and cardia.

J Thorac Cardiovasc Surg ; : — Hermanek P, Sobin LH, eds. Berlin: Springer Verlag, Surgical therapy of oesophageal carcinoma. Br J Surg ; 77 : — Siewert JR. Langenbecks Arch Chir ; : Neoadjuvant therapy for squamous cell esophageal carcinoma. Ann Oncol ; 5 : S17 —S Adjuvant therapy for cancer of the thoracic esophagus. World J Surg ; 18 : — Chemotherapy and combined-modality therapy for esophageal cancer.

Chest ; : S —S. Multimodal treatment for squamous cell esophageal cancer. World J Surg ; 19 : — Who benefits from neoadjuvant therapy of esophageal cancer. Dis Esoph ; 7 : — Postoperative radiation therapy does not increase survival after curative resection for squamous cell carcinoma of the middle and lower esophagus as shown by a multicenter controlled trial. Surg Gyn Obst ; : — Postoperative radiotherapy for carcinoma of the esophagus: a prospective, randomized controlled study. Japanese Oncology Group.

'Pathology' of gastric cancer

A comparison of chemotherapy and radiotherapy as adjuvant treatment to surgery for esophageal carcinoma. Chest ; : — Effect of surgical removal on the growth and kinetics of residual tumor. Cancer Res ; 39 : — Influence of the interval between primary tumor removal and chemotherapy on kinetics and growth of metastases.

Cancer Res ; 43 : — Presence of a growth stimulating factor in serum following primary tumor removal in mice. Cancer Res ; 49 : — Influence of irradiation of a primary tumor on labeling index and estrogen receptor index in a distant tumor focus. A mathematical model for relating drug sensitivity of tumors and their spontaneous mutation rate. Cancer Treat Rep ; 63 : — Effect of local or systemic treatment prior to primary tumor removal on the production and response to serum growth-stimulating factor in mice.

The value of preoperative radiotherapy in esophageal cancer. World J Surg ; 11 : — Preoperative radiotherapy for carcinoma of the esophagus. Low dose preoperative radiotherapy for carcinoma of the esophagus: results of a randomized clinical trial. Radiother Oncol ; 24 : — Randomized clinical trial on the combination of preoperative irradiation and surgery in the treatment of esophageal carcinoma.

Report on patients. Preoperative radiotherapy prolongs survival in operable esophageal carcinoma: a randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second Scandinavian trial in esophageal cancer. World J Surg ; 16 : — Randomized clinical trial of preoperative and postoperative adjuvant chemotherapy with cisplatin, vindesine, and bleomycine for carcinoma of the esophagus. J Thorac Cardiovasc Surg ; 96 : — Randomized trial of preoperative chemotherapy for squamous cell cancer of the esophagus.

Arch Surg ; : — Neoadjuvant chemotherapy in operable esophageal squamous cell cancer: an interim report of a randomized controlled trial. Milano: ISDE, a. Prospective randomized study of preoperative chemotherapy in the treatment of resectable esophageal carcinoma.

Randomized trial of combined preoperative chemotherapy versus surgery alone in operable squamous cell carcinoma of the esophagus. Preliminary results. Randomized phase III trial comparing surgery alone versus preoperative combined radiochemotherapy in stage I-II epidermoid cancer of the thoracic esophagus.

Preliminary analysis. Proc Am Soc Clin Oncol ; 13 : A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus. Cancer ; 73 : — Multimodality treatment plus surgery versus surgery alone for oesophageal squamous cell carcinoma. Combined modality treatment for locally advanced squamous cell esophageal carcinoma located at or above the level of the tracheal bifurcation. Recent Advances in Diseases of the Esophagus.

Tokyo: Springer Verlag, Cancer ; 68 : — Concurrent preoperative chemotherapy and radiation therapy in localized esophageal adenocarcinoma. Cancer ; 69 : — Improved survival with neoadjuvant therapy and resection for adenocarcinoma of the esophagus. Multimodality therapy for adenocarcinoma of the esophagus. Ann Thor Surg ; 59 : — Multimodality treatment plus surgery versus surgery alone for oesophageal adenocarcinoma. Preoperative chemotherapy for stage III-IV gastric carcinoma; Feasibility, response, and outcome after surgical resection. Br J Surg ; 82 : — Chemotherapy followed by resection for locally advanced adenocarcinoma of the esophagus or cardia.

A phase II study. Staging gastrointestinal cancer as a precondition for multimodal treatment. Combined preoperative chemotherapy and radiotherapy in patients with locally advanced esophageal cancer: interim analysis of a phase II trial. J Clin Oncol ; 14 : — Role of endoscopic ultrasonography in esophageal cancer. Endoscopy ; 25 : — Patterns of failure following combined modality therapy for esophageal cancer, Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus.

Treatment Strategies in Gastric Cancer

N Engl J Med ; : — This Article The Oncologist August vol. Services E-mail this article to a colleague Alert me when this article is cited Alert me if a correction is posted Alert me when eletters are published Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Download to citation manager. Responses Submit a response No responses published. Google Scholar Articles by Siewert, J.

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Multimodality Therapy for Esophageal Cancer

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