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.