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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2013, Vol. 7 Issue (2) : 172-179     DOI: 10.1007/s11684-013-0268-0
Present status and progress of neoadjuvant chemoradiotherapy for esophageal cancer
Jing Liu, Jinbo Yue, Ligang Xing, Jinming Yu()
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan 250117, China
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Trimodality based on neoadjuvant chemoradiotherapy (nCRT) followed by surgery is gaining popularity as a treatment strategy for locally advanced esophageal cancer. In this review, we summarize the role of nCRT and the recommended nCRT regimens based on clinical trials and meta-analyses. We analyze the relationship of nCRT with pathologic complete response (pCR) and then identify potential predictive markers of response. Compared with surgery alone and neoadjuvant chemotherapy followed by surgery, trimodality provides longer survival and has the advantage of local control compared with definitive chemoradiotherapy. The standard regimen is a platinum-based regimen with a radiation dose range of 41.4–50.4βGy by conventional fractionation. Evidence shows that patients with pCR tend to live longer than non-responders, indicating that pCR is a significant prognostic factor for patients with esophageal cancer. Individualized medicine requires predictive markers of individual patients based on their own genes. Currently, no definite marker is proved to be sufficiently sensitive and specific for use in clinical practice, although 18-fluorodeoxyglucose positron emission tomography shows promise in predicting response to nCRT.

Keywords esophageal cancer      neoadjuvant      chemoradiotherapy     
Corresponding Authors: Yu Jinming,   
Issue Date: 05 June 2013
URL:     OR
ReferencesSample size (pts)Histology(pts)RegimenResponseSurvival
Leichman et al. [29]93AC 93Oxaliplatin/5-FU/45GypCR: 28%Median survival: 28.3 months3-year survival:45.1%
Knox et al. [30]52AC 37SCC 15Irinotecan/cisplatin/40βGy+ 10βGy boostCR: 2%PR: 30%SD: 62PD: 6%Median survival: 36 months3-year survival: 51%
Zemanova et al. [31]107SCC 92AC 9Others 6Carboplatin/5-FU/45Gy, combined paclitaxel in 44 patientspCR: 20%Median survival: 18.0 months1-year survival: 56.7%2-year survival: 37.5%,3-year survival: 27.0%5-year survival: 21%No significant differences were found in survival when adding paclitaxel
Pasini et al. [32]74AC 37SCC 37Docetaxel/cisplatin/5-FU/50βGypCR: 47%Near pCR: 15%Median survival: 55 months3-year survival for pCR: 83%5-year survival for pCR: 77%
Emi et al. [33]7SCC 7Docetaxel/cisplatin/5-FU/ 61.2 GyCR: 57%PR: 29%PD: 14%NS
Ruhstaller et al. [34]66AC 36SCC 30Cisplatin/docetaxel/45βGypCR: 23%Near pCR: 24%Median survival: 36.5 months2-year survival: 66%3-year survival: 53%
Spigel et al. [35]49AC 34SCC 9Others 6Oxaliplatin/ docetaxel/ capecitabine/45βGypCR: 49%Median survival: 24.1 months1-year survival: 62.9%2-year survival: 52.2%3-year survival: 37.3%
Eisterer et al. [36]24AC 8SCC 16Cisplatin/docetaxel/5-FU/40 or 60 GypCR: 31%At a median follow-up of 16.5 months, 15 patients are alive
Zanoni et al. [37]155AC 65SCC 90Docetaxel/cisplatin/5-FU/ 50.4βGypCR: 41.9%Median survival: 36 months5-year survival: 43%
Lee et al. [38]19AC 16SCC 3Cetuximab/ irinotecan/ cisplatin/50.4 GypCR: 16%Median survival: 31 months
Bendell et al. [39]62AC 58SCC 4Bevacizumab/ erlotinib/ paclitaxel/ carboplatin/5-FU/45GyCR: 29%PR: 35%Median survival: 30.2 months
Idelevich et al. [40]28AC 22SCC 6Cisplatin/5-FU/ bevacizumabPR: 39%CR: 0%SD: 47%PD: 14%Median survival: 17 months1-year survival: 68%3-year survival: 20%
Ruhstaller et al. [41]28AC 15SCC 13Cisplatin/ docetaxel/ cetuximab/45βGypCR and near pCR: 68%6-month survival: 96%12-month survival: 86%
Tab.1  Trials with different chemoradiotherapy regimens
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