Neoadjuvant treatment of esophageal cancer

Table 1 Randomized controlled trials of adjuvant radiotherapy vs surgery alone for esophageal cancer

Studies	Histology	Treatment	n	MS (mo)	5-yr OS (%)	P	RT dose (Gy)
Kunath et al[44], 1984	SCC	ART	23	9		NS	50-55
		Surgery	21	6
Ténière et al[45], 1991	SCC	ART	102	18	19	NS	45-55
		Surgery	119	18	19
Fok et al[36], 1993	SCC	ART	42	11	10	NS	43-53
		Surgery	39	22	16
Zieren et al[46], 1995	SCC	ART	33		231	NS	56
		Surgery	35		221
Xiao et al[47], 2003	AC/SCC	ART	220		41	NS	50-60
		Surgery	275		32

¹3-year OS. MS: Median survival; RT: Radiotherapy; SCC: Squamous cell carcinoma; AC: Adenocarcinoma; ART: Adjuvant radiotherapy; NS: Not significant; OS: Overall survival.

Table 2 Randomized controlled trials of neoadjuvant radiotherapy vs surgery alone for esophageal cancer

Studies	Histology	Treatment	n	MS (mo)	5-yr OS (%)	P	RT dose (Gy)
Launois et al[48], 1981	SCC	NART	77	10	10	NS	40
		Surgery	57	12	12
Gignoux et al[49], 1987	SCC	NART	106	11	11	NS	33
		Surgery	102	11	10
Arnott et al[50], 1992	AC/SCC	NART	90	8	9	NS	20
		Surgery	86	8	17
Nygaard et al[51], 1992	SCC	NART	481		213	NS	35
		Surgery	412		93
Wang et al[52], 1989	SCC	NART	104		35	NS	40
		Surgery	102		30

¹Group 3: NART;

²Group 1: Surgery alone;

³3-year OS. MS: Median survival; RT: Radiotherapy; SCC: Squamous cell carcinoma; AC: Adenocarcinoma; NART: Neoadjuvant radiotherapy; NS: Not significant; OS: Overall survival.

Table 3 Randomized controlled trials of adjuvant chemotherapy vs surgery alone for esophageal cancer

Studies	Histology	Treatment	n	MS (mo)	5-yr OS (%)	P
Pouliquen et al[54], 1996	SCC	CF	52	13		NS
		Surgery	68	14
Ando et al[55], 1997	SCC	CV	100		45	NS
		Surgery	105		48
Ando et al[56], 2003	SCC	CF	120		61	NS
		Surgery	122		52

MS: Median survival; SCC: Squamous cell carcinoma; C: Cisplatin; F: Fluorouracil; V: Vindesine; NS: Not significant; OS: Overall survival.

Table 4 Randomized controlled trials of neoadjuvant chemotherapy vs surgery alone for esophageal cancer

Studies	Histology	Treatment	n	MS (mo)	3-yr OS (%)	P
Schlag et al[57], 1992	SCC	CF	22	7		NS
		Surgery	24	6
Nygaard et al[51], 1992	SCC	BC	44	7	3	NS
		Surgery	41	7	9
Maipang et al[58], 1994	SCC	BVC	24	17	31	NS
		Surgery	22	17	36
Law et al[59], 1997	SCC	CF	74	17	40	NS
		Surgery	73	13	13
Kelsen et al[32], 1998	AC/SCC	CF	213	15	191	NS
		Surgery	227	16	201
Ancona et al[60], 2001	SCC	CF	47	25	341	NS
		Surgery	47	24	221
MRC[61], 2002	AC/SCC	CF	400	17	43	< 0.01
		Surgery	402	13	34

¹5-year OS. MS: Median survival; SCC: Squamous cell carcinoma; AC: Adenocarcinoma; C: Cisplatin; F: Fluorouracil; B: Bleomycin; V: Vindesine; NS: Not significant; OS: Overall survival.

Table 5 Randomized controlled trials of perioperative chemotherapy vs surgery alone for esophageal cancer

Studies	Histology	Treatment	n	MS (mo)	5-yr OS (%)	P
Roth et al[67], 1988	AC/SCC	BVC	19	9	25	NS
		Surgery	20	9	5
Kelsen et al[32], 1998	AC/SCC	CF	2131	15	19	NS
		Surgery	227	16	20
Cunningham et al[68], 2006	AC2	ECF	250	24	36	NS
		Surgery	253	20	23
Boige et al[69], 2007	AC3	CF	1134		38	< 0.05
		Surgery	111		24

¹Of 213 patients in the perioperative arm, only 66 later received adjuvant chemotherapy;

²26% had AC of the GEJ and lower esophagus;

³11% had esophageal AC;

⁴Of 113 patients in the perioperative arm, only 54 later received adjuvant chemotherapy. MS: Median survival; SCC: Squamous cell carcinoma; AC: Adenocarcinoma; B: Bleomycin; C: Cisplatin; V: Vindesine; F: Fluorouracil; E: Epirubicin; NS: Not significant; OS: Overall survival.

Table 6 Randomized controlled trials of neoadjuvant and adjuvant chemoradiotherapy vs surgery alone for esophageal cancer

Studies (yr)	Histology	Treatment	n	MS (mo)	5-yr OS (%)	P
Nygaard et al[51], 19921	SCC	BC + 35 Gy	47	8	173	NS
		Surgery	41	7	93
Apinop et al[75], 19941	SCC	CF + 20 Gy	35	10	24	NS
		Surgery	34	7	10
Le Prise et al[76], 19941	SCC	CF + 20 Gy	41	10	193	NS
		Surgery	45	11	143
Walsh et al[77], 19961	AC	CF + 40 Gy	58	16	323	< 0.05
		Surgery	55	11	63
Bosset et al[33], 19971	SCC	C + 37 Gy	143	19	7	NS
		Surgery	139	19	9
Urba et al[78], 20011	AC/SCC	CFV + 45 Gy	50	17	20	NS
		Surgery	50	18	10
Lee et al[79], 20041	SCC	CF + 45 Gy	51	28	493	NS
		Surgery	50	27	413
Burmeister et al[80], 20051	AC/SCC	CF + 35 Gy	128	22	17	NS
		Surgery	128	19	13
Tepper et al[81], 20081	AC/SCC	CF + 50.4 Gy	30	54	39	< 0.01
		Surgery	26	21	16
Macdonald et al[82], 20012	AC4	F + 45 Gy	281	36	503	< 0.01
		Surgery	275	27	413

¹Neoadjuvant chemoradiotherapy;

²Adjuvant chemoradiotherapy;

³3-year OS;

⁴20% of patients enrolled had AC of the gastroesophageal junction (GEJ). MS: Median survival; SCC: Squamous cell carcinoma; AC: Adenocarcinoma; B: Bleomycin; C: Cisplatin; F: Fluorouracil; V: Vindesine; NS: Not significant; OS: Overall survival.