Systemic treatment of oesophageal cancer

• Published in: European journal of gastroenterology & hepatology Vol. 16; no. 3; p. 249
• Main Authors: Richel, Dirk J, Vervenne, Walter L
• Format: Journal Article
• Language: English
• Published: England 01.03.2004
• Subjects: Antineoplastic Agents - therapeutic use; Combined Modality Therapy - methods; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - radiotherapy; Esophageal Neoplasms - surgery; Humans; Neoplasm Metastasis - drug therapy; Palliative Care - methods; Postoperative Care - methods; Preoperative Care - methods; Randomized Controlled Trials as Topic; Treatment Outcome
• ISSN: 0954-691X
• DOI: 10.1097/00042737-200403000-00002

Most patients with oesophageal cancer present with locally advanced or metastatic disease. In an effort to improve the results of surgery in patients with operable disease, strategies to incorporate radiotherapy and chemotherapy, preoperatively (neoadjuvant) and postoperatively (adjuvant), have been extensively investigated in numerous clinical trials. Meta-analyses of neoadjuvant trials did not demonstrate a survival advantage for neoadjuvant chemotherapy or concurrent chemoradiotherapy. Although local control seems to be improved with neoadjuvant treatment, the currently used chemotherapeutic agents are simply not effective enough to eradicate micro-metastatic disease. Patients who undergo neoadjuvant treatment and achieve a histologically confirmed complete response have a significant better survival than those who do not achieve such a response. Although neoadjuvant chemoradiotherapy is able to induce a higher rate of complete pathological responses compared to neoadjuvant chemotherapy (25-30% vs 5-15%), this advantage is counteracted by a higher incidence of operative mortality. In patients with metastatic disease there is no evidence that chemotherapy (cisplatin, 5-fluorouracil and anthracyclins) improves survival. Several new agents such as taxanes, irinotecan and vinorelbine in combination with cisplatin and carboplatin have shown promising activity in neoadjuvant settings and as palliative treatment of metastatic oesophageal cancer. However, the benefit of these new drugs in the treatment of oesophageal cancer has to be confirmed in randomized trials.