Curative Treatment for Esophageal Cancer: Systematic Review of Neoadjuvant Therapy and Chemoradiotherapy Alone

Esophageal cancer is fairly rare in Québec. In 2008, the number of new cases among men was estimated at 260 and the number of deaths, at 250. Data is not available for women. Different therapeutic modalities are proposed, including surgery, on the one hand, and chemotherapy, radiotherapy or chemoradiotherapy, alone or combined with surgery, on the other. The survival rates being very low even after treatment, the use of these different approaches is widely debated.

This report was produced at the request of the Direction de la lutte contre le cancer on the recommendation of the Comité de l’évolution des pratiques en oncologie (CEPO). It is a systematic review on the relative efficacy of neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy and chemoradiotherapy without surgery for the curative treatment of cancer of the esophagus and gastro-esophageal junction.

AETMIS concludes that the available data do not allow to select the most effective therapeutic option among the treatments examined in this report. The choice of therapeutic management depends on the tumour’s histological type and stage and on the patient’s clinical status. It has been established that patients who respond well to neoadjuvant therapy have a better prognosis and better chances of survival. Nevertheless, there are currently no criteria for defining the profile of patients likely to respond to neoadjuvant therapy in order to target them better.