Results from a recent clinical trial suggest neoadjuvant treatment of esophageal cancer is promising but requires further evaluation, as reported in the Journal of Clinical Oncology.
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, the survival rate 3 years following treatment is poor, so 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 is 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, results from one clinical trial indicated a significantly improved survival in patients receiving neoadjuvant therapy compared to surgery alone. In addition, data analyzed involving treatment and outcomes of patients treated at the University of Michigan between 1985 and 1987 indicated that patients who had been treated with neoadjuvant chemotherapy and radiation had an improved survival time that was over double that of patients treated with surgery alone. These statistics have prompted further investigation into the treatment strategy involving neoadjuvant therapy for this group of patients.
Researchers at the University of Michigan conducted a small clinical trial directly comparing neoadjuvant chemotherapy and radiation therapy to surgery alone. All patients had cancer that was confined to the esophagus and regional lymph nodes. Half of the patients received combination chemotherapy consisting of cisplatin, vinblastine and 5-fluorouracil plus radiation therapy prior to the surgical removal of their cancer. The other half of patients underwent only surgery. Both treatments were well-tolerated, with 2 treatment related deaths occurring in the group of patient receiving only surgery and one treatment-related death in the group of patients receiving neoadjuvant therapy.
There was no difference in the average duration of survival for patients receiving neoadjuvant treatment (17.6 months) compared to 16.9 months for patients treated with surgery alone. Three years following treatment, however, 30% of patients treated with neoadjuvant therapy survived compared to only 16% of patients treated with surgery alone. Moreover, 28% of patients receiving neoadjuvant therapy survived without a cancer recurrence compared to only 16% of patients who were treated with surgery alone.
Further investigation of neoadjuvant treatment of esophageal cancer is warranted. Future clinical trials are needed to accurately determine the potentially superior effects of this treatment strategy. Refined statistical analyses and larger participation may be crucial factors that were not properly addressed in this trial.
Patients with esophageal cancer may wish to speak with their physician about the risks and benefits of participating in a clinical trial further evaluating neoadjuvant treatment strategies or other promising treatment strategies. provides personalized clinical trial searches on behalf of patients.
(Journal of Clinical Oncology, Volume 19, No 2, pp 305-313, 2001)