Preoperative treatment of locally advanced esophageal carcinoma

Abstract

Esophageal cancer (EC) is an aggressive malignancy with increasing incidence worldwide. Surgery is still the most effective treatment, however, both the high rate of local and distant recurrences and surgery-related complications led us to investigate new preoperative strategies. In this review, we discuss the role of neoadjuvant therapy for locally advanced EC with a focus on preoperative chemoradiation (trimodality treatment). Furthermore, the last fifteen years of published literature and our experience have been also reviewed. In the preoperative setting, few trials have reported a significant benefit with fluoropyrimidine and platinum compound-based neoadjuvant chemotherapy, compared to surgery alone. A large number of phase III trials and meta-analyses have demonstrated improved outcomes with preoperative chemoradiation vs. neoadjuvant chemotherapy or surgery alone. Therefore, trimodality therapy can be considered the most effective option in the management of locally advanced EC. Addition of drugs targeting VEGF or HER2 to standard chemotherapy appears to be feasible but needs to be explored more accurately. FDG-PET may predict both response to neoadjuvant treatments and prognosis.

Diallyl disulfide induces G2/M arrest and promotes apoptosis through the p53/p21 and MEK-ERK pathways in human esophageal squamous cell carcinoma

“…Current treatment generally employs surgical resection combined with chemotherapy and radiotherapy for advanced ESCC. However, both the high recurrence rate and strong systemic toxicity of the anticancer treatments led us to investigate new agents to improve the therapeutic effect (2).…”

To study the short-term outcome of multimodality treatment on morbidity and quality of life in patients with carcinoma oesophagus

“…13,14 The metaanalysis conducted by Arnott et al reported a poor benefit rate with preoperative radiotherapy alone. 15 Burmeister BH et al found that most published randomized clinical trials comparing local modalities have not shown a survival benefit but rather one in terms of local control and improved resectability where surgery has been involved. 16 Upfront surgery with adjuvant therapy and survival, in present present study 4 patients who received postoperative radiation therapy 2 patients expired following surgery due to pulmonary sepsis, it was observed that survival was not improved significantly with the addition of RT, comparing with the study done by Xion et al included 495 patients with SCC of the oesophagus who received postoperative radiation therapy (n=220) or surgery alone (n=275) and survival was not improved significantly with the addition of RT (only change observed was of from 32% to 41%).…”

Treatment Outcomes and Survival of Patients with Gastric Cancer in Hamadan, Iran: A Retrospective Study

“…The results showed that surgery was the best and only primary treatment for most GCs that had spread to lymphomas. Adjuvant therapies such as CT and chemoradiotherapy can reduce the complications of the disease that has spread to lymphomas (9). In a review study conducted by Repka et al In the United States, various evidences were examined to evaluate the effect of RT on the treatment of GC.…”

“…Some usual CT medicines are 5-Fluorouracil, Cisplatin, Capecitabine, Fluropyrimidine, and Oxaliplatin. For HER2+ patients in stage four, the trastuzumab is used, but in CT, before surgery, 5-Fluorouracil, Cisplatin, and Capecitabine are common (9). Although all of these treatments are acceptable according to the recommended protocols, their outcomes have not been fully studied especially in eastern countries.…”