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According to a recent article published in the Lancet, pre-operative chemotherapy appears to improve survival compared to surgery alone for patients with operable esophageal cancer.

The esophagus is a muscular tube that conveys food from the back of the throat to the stomach. Operable esophageal cancer refers to cancer that is confined to the site of origin, or to local lymph nodes. Standard treatment options for patients with this disease may consist of surgery, radiation therapy and/or chemotherapy. 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.

Researchers from the Medical Research Council Oesophageal Cancer Working Party recently conducted a clinical trial evaluating neoadjuvant chemotherapy in patients with operable esophageal cancer. This trial involved 802 patients who had not received prior therapy. Patients were divided into two groups; one group received neoadjuvant chemotherapy consisting of Platinol® (cisplatin) and 5-FU (fluorouracil), and the other group received no chemotherapy. Patients from both groups were allowed to receive neoadjuvant radiation.

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Complete surgical removal of the cancer occurred in 60% of patients treated with neoadjuvant chemotherapy, compared to 54% of patients not receiving neoadjuvant chemotherapy. Complications immediately following surgery did not differ between the two groups. Overall survival was 16.8 months for patients treated with neoadjuvant chemotherapy, compared to 13.3 months for patients treated with just surgery. Two years following therapy, 43% of patients treated with neoadjuvant chemotherapy were alive, compared to only 34% of patients treated with just surgery.

These researchers concluded that neoadjuvant chemotherapy appears to improve survival in patients with operable esophageal cancer. Furthermore, the results from this trial indicate that post-operative complications were not increased due to neoadjuvant therapy. Patients with operable esophageal cancer may wish to speak with their physician about the risks and benefits of neoadjuvant chemotherapy or the participation in a clinical trial evaluating novel therapeutic approaches. Two sources of information regarding ongoing clinical trials include the National Cancer Institute ( also provides personalized clinical trial searches on behalf of patients.

Reference: Bancewica J, Clark P, Smith D, et al. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomized controlled trial.

Lancet. 2002;9319:1727-1733.