Preoperative chemoradiation for the treatment of locoregional esophageal cancer: the standard of care?

Esophageal cancer has one of the highest mortality rates among patients with solid tumors. Surgical resection has been a cornerstone of treatment for localized esophageal cancer, but recently treatment strategies have become more aggressive and now include chemotherapy, radiation, and surgery. Two meta-analyses confirmed a survival benefit at 3 years from neoadjuvant concurrent chemoradiation without compromising the ability to undergo surgical resection and without an increase in peri-operative mortality negating the benefit seen. Some countries prefer to use pre-operative chemotherapy, although this is not standard in the United States. Patients who undergo initial esophagectomy with no pre-operative treatment may benefit from post-operative adjuvant chemoradiation depending on the final pathologic staging. Ultimately, treatment planning should include a multi-disciplinary evaluation of the patient, with consideration of available treatment options and their risks and benefits. There is no absolute standard that is best for all patients; rather, the physician and patient working in concert eventually determine which of several reasonable treatment options is best suited for that individual patient.