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.
. Present status and progress of neoadjuvant chemoradiotherapy for esophageal cancer[J]. Frontiers of Medicine, 2013, 7(2): 172-179.
Jing Liu, Jinbo Yue, Ligang Xing, Jinming Yu. Present status and progress of neoadjuvant chemoradiotherapy for esophageal cancer. Front Med, 2013, 7(2): 172-179.
Carboplatin/5-FU/45Gy, combined paclitaxel in 44 patients
pCR: 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]
74
AC 37SCC 37
Docetaxel/cisplatin/5-FU/50βGy
pCR: 47%Near pCR: 15%
Median survival: 55 months3-year survival for pCR: 83%5-year survival for pCR: 77%
Emi et al. [33]
7
SCC 7
Docetaxel/cisplatin/5-FU/ 61.2 Gy
CR: 57%PR: 29%PD: 14%
NS
Ruhstaller et al. [34]
66
AC 36SCC 30
Cisplatin/docetaxel/45βGy
pCR: 23%Near pCR: 24%
Median survival: 36.5 months2-year survival: 66%3-year survival: 53%
Spigel et al. [35]
49
AC 34SCC 9Others 6
Oxaliplatin/ docetaxel/ capecitabine/45βGy
pCR: 49%
Median survival: 24.1 months1-year survival: 62.9%2-year survival: 52.2%3-year survival: 37.3%
Eisterer et al. [36]
24
AC 8SCC 16
Cisplatin/docetaxel/5-FU/40 or 60 Gy
pCR: 31%
At a median follow-up of 16.5 months, 15 patients are alive
Median survival: 17 months1-year survival: 68%3-year survival: 20%
Ruhstaller et al. [41]
28
AC 15SCC 13
Cisplatin/ docetaxel/ cetuximab/45βGy
pCR and near pCR: 68%
6-month survival: 96%12-month survival: 86%
Tab.1
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