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According to an article recently published in Lancet Oncology, chemotherapy plus radiation therapy prior to surgery improves survival compared with surgery alone in patients with local esophageal cancer.

The esophagus is a tube that connects the back of the throat to the stomach. Local esophageal cancer refers to cancer that has not spread from its site of origin to distant sites in the body.

Standard treatment for local esophageal cancer includes surgery (if possible), chemotherapy, and radiation therapy. Neoadjuvant therapy (treatment prior to surgery), including chemotherapy and radiation therapy, is often used to reduce the size of the cancer prior to surgery; this allows for more complete surgical removal of the cancer. In addition, neoadjuvant therapy is thought to immediately kill cancer cells that may be in the body. However, the effects of neoadjuvant therapy on survival among patients with local esophageal cancer have not yet been established.

Researchers from Australia recently evaluated data including clinical trials involving patients with local esophageal cancer treated with neoadjuvant therapy in an attempt to determine if this treatment strategy may improve survival. This data included the following: 10 clinical trials that involved 1,209 patients and compared neoadjuvant chemotherapy plus radiation (chemoradiotherapy) therapy followed by surgery with surgery alone; eight clinical trials including 1,724 patients that compared neoadjuvant chemotherapy followed by surgery with surgery alone in the treatment of local esophageal cancer.

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  • Survival was improved by nearly 20% among patients treated with neoadjuvant chemoradiotherapy compared with those treated with surgery alone.
  • Survival was improved by 10% among patients treated with neoadjuvant chemotherapy compared with those treated with surgery alone.

The researchers concluded that neoadjuvant therapy, particularly neoadjuvant chemoradiotherapy, significantly improves survival compared to surgery alone among patients with local esophageal cancer. Patients with localized esophageal cancer may wish to speak with their physician regarding their individual risks and benefits of undergoing treatment with neoadjuvant therapy; different cellular types may respond differently to treatment and there are side effects associated with this therapy.

Reference: Gebski V, Burmeister B, Smithers B, et al. Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncology. 2007; 8:226-234.