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Neoadjuvant (prior to surgery) therapy consisting of chemotherapy and radiation improves long-term survival in patients with early stage esophageal cancer, according to a recent article published in the Archives of Surgery.

The esophagus is a muscular tube that conveys food from the back of the throat to the stomach. Locally advanced esophageal cancer refers to cancer that is confined to the esophagus and regional lymph nodes. Standard treatment options for patients with this disease may consist of surgery, radiation therapy and/or chemotherapy. However, esophageal cancer is considered a very deadly cancer and the survival rate 3 years following treatment is poor. Researchers are continually evaluating new treatment strategies in order to improve upon long-term survival for these patients.

Neoadjuvant therapy refers to treatment prior to surgery, usually chemotherapy and/or radiation. It has the potential advantages of delivering immediate anti-cancer therapy to destroy any cancer cells that may have already spread away from the esophagus and to reduce the size of the cancer, allowing for easier and more complete surgical removal. The role of neoadjuvant chemotherapy and radiation in patients with localized cancer of the esophagus has been controversial. In some clinical studies, the death rate following surgery has been increased in patients receiving neoadjuvant chemotherapy and radiation therapy, negating any benefit from control of cancer. Conversely, other clinical trials have reported a survival benefit for patients receiving neoadjuvant therapy. These discrepancies have prompted researchers to continue clinical trials evaluating this issue.

Recently, long-term follow-up from a multi-institutional trial involving patients with esophageal cancer who received neoadjuvant therapy has been completed. Neoadjuvant therapy consisted of 5-fluorouracil, cisplatin, interferon alfa and concurrent radiation therapy. Approximately 82% of patients were able to complete neoadjuvant therapy. Three years following treatment, 34% of patients survived, with the average survival duration of these patients not yet reached.

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These results indicate that long-term survival may be achieved with neoadjuvant therapy by a significant portion of patients with locally advanced esophageal cancer. The researchers conducting this trial report that cancer recurrence is unlikely in patients who survive 3 years or long following this treatment regimen. Patients with esophageal cancer may wish to speak with their physician about the risks and benefits of neoadjuvant therapy or participation in a clinical trial further evaluating this treatment strategy.​

(Archives of Surgery, Vol 136, No 7, pp 737-742, 2001).