Indian Journal of Surgical Oncology

, Volume 4, Issue 2, pp 96–104 | Cite as

Multimodality Management of Esophageal Cancer

  • Keduovinuo K. Keditsu
  • Sabita Jiwnani
  • George Karimundackal
  • C. S. Pramesh
Review Article

Abstract

Esophageal cancer is a highly lethal and aggressive disease and a major public health problem worldwide. The incidence of esophageal cancer in the western hemisphere has increased by 400 % in the past few decades (Posner et al. 2011). Surgery is the mainstay of definitive management of esophageal cancer; however, the results of surgery alone have been dismal, with survival rates of approximately 15 to 20 % at 5 years (Hingorani et al., Clin Oncol 23:696705, 2011). The last three decades have seen growing interest in various adjuvant and neoadjuvant treatment strategies, with an aim to improve disease control and overall survival. However, due to conflicting and often contradictory results, there was controversy on the ideal treatment paradigm. Recent evidence suggests an improvement in overall survival with neoadjuvant therapy, both chemotherapy and chemoradiotherapy, over surgery. In this review we address various issues concerning multimodality management of locally advanced esophageal cancers: Does neoadjuvant therapy offer a definite benefit over surgery alone? If so, which neoadjuvant strategy? Does the survival benefit outweigh the increased treatment related toxicity/morbidity? Finally, is neoadjuvant treatment the standard of care for locally advanced resectable esophageal cancer?

Keywords

Locally advanced esophageal carcinoma Squamous cell carcinoma Adenocarcinoma Neoadjuvant chemoradiation Neoadjuvant chemotherapy 

References

  1. 1.
    Posner MC, Minsky BD, Ilson DH (2011) Cancer of the esophagus. In: Devita VT (ed) Cancer principles & practice of oncology, 9th edn. Lippincott Williams & Wilkins, Philadelphia, pp 887–923Google Scholar
  2. 2.
    Hingorani M, Crosby T, Maraveyas A et al (2011) Neoadjuvant chemoradiotherapy for resectable oesophageal and gastro-oesophageal junction cancerdo we need another randomised trial? Clin Oncol 23:696–705CrossRefGoogle Scholar
  3. 3.
    Kamangar F, Dores GM, Anderson WF et al (2006) Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 24:37–50CrossRefGoogle Scholar
  4. 4.
    Dikshit R, Gupta PC, Ramasundarahettige C et al (2012) Cancer mortality in India: a nationally representative survey. Lancet 379:1807–1816PubMedCrossRefGoogle Scholar
  5. 5.
    Jemal A, Bray F, Center M et al (2011) Global cancer statistics. CA Cancer J Clin 61:69–90PubMedCrossRefGoogle Scholar
  6. 6.
    Siegel R, Naishadham D, Jemal A (2012) Cancer statistics 2012. CA Cancer J Clin 62:10–29PubMedCrossRefGoogle Scholar
  7. 7.
    Bhansali MS, Vaidya JS, Bhatt RG et al (1996) Chemotherapy for carcinoma of the esophagus: a comparison of evidence from meta-analyses of randomized trials and of historical control studies. Ann Oncol 7:335–355CrossRefGoogle Scholar
  8. 8.
    Kelsen DP, Winter KA, Gunderson LL et al (2009) Long-term results of RTOG Trial 8911 (USA Intergroup113): a random assignment trial comparison of chemotherapy followed by surgery compared with surgery alone for esophageal cancer. J Clin Oncol 27:5062–5067CrossRefGoogle Scholar
  9. 9.
    Medical Research Council Oesophageal Cancer Working Party (2002) Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet 359:1727–1733CrossRefGoogle Scholar
  10. 10.
    Campbell NP, Villaflor VM (2010) Neoadjuvant treatment of esophageal cancer. World J Gastroenterol 16(30):3793–3803PubMedCrossRefGoogle Scholar
  11. 11.
    Ancona E, Ruol A, Santi S et al (2001) Only pathologic complete response to neoadjuvant chemotherapy improves significantly the long-term survival of patients with resectable esophageal squamous cell carcinoma. Cancer 91(11):2165–2174PubMedCrossRefGoogle Scholar
  12. 12.
    Roth JA, Pass HI, Flanagan MM et al (1992) Randomized clinical trial of preoperative and postoperative adjuvant chemotherapy with cisplatin, vindesine, and bleomycin for carcinoma of the esophagus. J Thorac Cardiovasc Surg 96:242–248Google Scholar
  13. 13.
    Schlag PM (1992) Randomized trial of preoperative chemotherapy for squamous cell cancer of the esophagus. The Chirurgische Arbeitsgemeinschaft Fuer Onkologie der Deutschen Gesellschaft Fuer Chirurgie Study Group. Arch Surg 127:1446–1450PubMedCrossRefGoogle Scholar
  14. 14.
    Law S, Fok M, Chow S et al (1997) Preoperative chemotherapy versus surgical therapy alone for squamous cell carcinoma of the esophagus: a prospective randomized trial. J Thorac Cardiovasc Surg 114:210–217PubMedCrossRefGoogle Scholar
  15. 15.
    Mandard AM, Dalibard F, Mandard JC et al (1994) Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer 73:2680–2686PubMedCrossRefGoogle Scholar
  16. 16.
    Urschel JD, Vasan H, Blewett CJ (2002) A meta-analysis of randomized controlled trials that compared neoadjuvant chemotherapy and surgery to surgery alone for resectable esophageal cancer. Am J Surg 183:274–279PubMedCrossRefGoogle Scholar
  17. 17.
    Allum WH, Stenning SP, Bancewicz J et al (2009) Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer. J Clin Oncol 27:5062–5067PubMedCrossRefGoogle Scholar
  18. 18.
    Sjoquist KM, Burmeister BH, Smithers BM et al (2011) Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol 12:681–692PubMedCrossRefGoogle Scholar
  19. 19.
    Boonstra JJ, Kok T, Wijnhoven BPL et al (2011) Chemotherapy followed by surgery versus surgery alone in patients with resectable oesophageal squamous cell carcinoma: longterm results of a randomized controlled trial. BMC Cancer 11:181PubMedCrossRefGoogle Scholar
  20. 20.
    Ychou M, Boige V, Pignon J-P et al (2011) Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 29:1715–1721PubMedCrossRefGoogle Scholar
  21. 21.
    Barnett SA, Rizk NP (2010) Randomized clinical trials in esophageal carcinoma. Surg Oncol Clin N Am 19:59–80PubMedCrossRefGoogle Scholar
  22. 22.
    Hagen PV, Hulshof MCCM, Lanschot JJBV et al (2012) Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366:2074–2084PubMedCrossRefGoogle Scholar
  23. 23.
    Staal EFWC, Aleman BMP, Boot H et al (2010) Systematic review of the benefits and risks of neoadjuvant chemoradiation for oesophageal cancer. Br J Surg 97:1482–1496CrossRefGoogle Scholar
  24. 24.
    Donahue JM, Nichols FC, Li Z et al (2009) Complete pathologic response after neoadjuvant chemoradiotherapy for esophageal cancer is associated with enhanced survival. Ann Thorac Surg 87:392–399PubMedCrossRefGoogle Scholar
  25. 25.
    Brucher BL, Stein HJ, Zimmermann F et al (2004) Responders benefit from neoadjuvant radiochemotherapy in esophageal squamous cell carcinoma: results of a prospective phase-II trial. Eur J Surg Oncol 30:963–971PubMedGoogle Scholar
  26. 26.
    Reynolds JV, Muldoon C, Hollywood D et al (2007) Long-term outcomes following neoadjuvant chemoradiotherapy for esophageal cancer. Ann Surg 245:707–716PubMedCrossRefGoogle Scholar
  27. 27.
    Fiorica F, Di Bona D, Schepis F et al (2004) Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis. Gut 53:925–930PubMedCrossRefGoogle Scholar
  28. 28.
    Bosset JF, Gignoux M, Triboulet JP et al (1997) Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 337:161–167PubMedCrossRefGoogle Scholar
  29. 29.
    Stahl M, Walz MK, Stuschke M et al (2009) Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol 27:851–856PubMedCrossRefGoogle Scholar
  30. 30.
    Gebski V, Burmeister B, Smithers BM et al (2007) Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 8:226–234PubMedCrossRefGoogle Scholar
  31. 31.
    Kaklamanos IG, Walker GR, Ferry K et al (2003) Neoadjuvant treatment for resectable cancer of the esophagus and the gastroesophageal junction: a meta-analysis of randomized clinical trials. Ann Surg Oncol 10(7):754–761PubMedCrossRefGoogle Scholar
  32. 32.
    Malthaner RA, Wong RKS, Rumble RB et al (2004) Neoadjuvant or adjuvant therapy for resectable esophageal cancer: a systematic review and meta-analysis. BMC Med 2:35PubMedCrossRefGoogle Scholar
  33. 33.
    Greer SE, Goodney PP, Sutton JE et al (2005) Neoadjuvant chemoradiotherapy for esophageal carcinoma: a meta-analysis. Surgery 137:172–177PubMedCrossRefGoogle Scholar
  34. 34.
    Kranzfelder M, Schuster T, Geinitz H et al (2011) Meta-analysis of neoadjuvant treatment modalities and definitive non-surgical therapy for oesophageal squamous cell cancer. Br J Surg 98:768–783PubMedCrossRefGoogle Scholar

Copyright information

© Indian Association of Surgical Oncology 2013

Authors and Affiliations

  • Keduovinuo K. Keditsu
    • 1
  • Sabita Jiwnani
    • 1
  • George Karimundackal
    • 1
  • C. S. Pramesh
    • 1
  1. 1.Division of Thoracic Surgery, Department of Surgical OncologyTata Memorial HospitalMumbaiIndia

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