Neoadjuvant Therapy in Esophageal Cancer

Locally advanced esophageal cancer has a dismal prognosis. Surgery remains the cornerstone treatment with 5-year survival rates of approximately 12-39%. Rates of local failure and distant metastases are high following surgical resection of locally advanced tumors. Neoadjuvant therapy (either radiation therapy, chemotherapy, or a combination) prior to surgery carries the advantage of tackling micrometastases and improving complete resection rates. Neoadjuvant concurrent chemotherapy and radiotherapy are a favored approach with evidence for improved pathologic complete response (pCR) rates and improved survival compared with surgery alone. Randomized trials of the optimal neoadjuvant approach are ongoing.