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Past
Neoadjuvant chemoradiotherapy for resectable esophageal cancer has become standard practice, based on the Dutch CROSS study.1,2 This therapy consists of five cycles of carboplatin/paclitaxel with concurrent radiotherapy (41.4 Gy); however, the role of intensified neoadjuvant chemoradiotherapy with a higher dose of both chemotherapy and radiotherapy is unclear.
Present
We analyzed a cohort of 176 patients with potentially resectable esophageal cancer treated with intensified neoadjuvant chemoradiotherapy (six cycles of carboplatin/paclitaxel with concurrent radiotherapy [50.4 Gy]),3 and found that our intensified regimen was feasible but adverse events occurred frequently. Although high rates of pathological complete responses were seen, a survival benefit, compared with conventional neoadjuvant chemoradiotherapy, seems lacking.
Future
Due to the retrospective nature of our study design, a randomized trial is needed to identify the added value of intensified neoadjuvant chemoradiotherapy for resectable esophageal cancer. Until then, we advise against intensification of neoadjuvant therapy.
References
van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366:2074–84.
Shapiro J, van Lanschot JJB, Hulshof MCCM, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol. 2015;16:1090–98.
Boers J, Joldersma A, van Dalsen AD, et al. Intensified neoadjuvant chemoradiotherapy for patients with potentially resectable esophageal cancer: a retrospective cohort study. Ann Surg Oncol. 2019. https://doi.org/10.1245/s10434-019-08114-z.
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Jorianne Boers and Jan Willem B. de Groot report no conflicts of interest.
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ASO Author Reflections is a brief invited commentary on the article “Intensified Neoadjuvant Chemoradiotherapy for Patients with Potentially Resectable Esophageal Cancer: A Retrospective Cohort Study,” Ann Surg Oncol. 2019. https://doi.org/10.1245/s10434-019-08114-z.
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Boers, J., de Groot, J.W.B. ASO Author Reflections: Intensified Neoadjuvant Chemoradiotherapy Followed by Esophagectomy in Esophageal Cancer. Ann Surg Oncol 27, 1529 (2020). https://doi.org/10.1245/s10434-020-08276-1
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DOI: https://doi.org/10.1245/s10434-020-08276-1