Radiation and chemoradiation therapy for esophageal adenocarcinoma

The aims of preoperative chemoradiation therapy (preop‐CRT) for esophageal adenocarcinoma are to reduce incomplete local resection (R1,R2), local and systemic recurrences that are reported in up to 30% of patients who undergo surgery alone. Phase II studies of preop‐CRT, with radiation doses in the 40–50 Gy range, and concurrent chemotherapy with 5‐fluorouracil (5‐FU)–cisplatin ± paclitaxel, or cisplatin–paclitaxel, have reported subsequent RO resection rates of 80%–100%, with tumor sterilization achieved in 8%–49% of cases, and consequently improved local control. New chemotherapy regimens omitting 5‐FU have reduced the incidence of severe esophagitis, unplanned hospitalization, with comparable efficacy. Among three randomised trials that compared preop‐CRT to surgery alone, one shown a debatable survival advantage. Reducing local recurrence rates lead to a switch to more distant failures, and increasing the radiation dose beyond 45 Gy appears to be of little value. However, it should be remembered that preop‐CRT has associated toxicity, and may increase postoperative mortality. Novel strategies, which include induction with chemotherapy followed by preop‐CRT, and for radiation therapy, three dimensional conformation techniques, image fusioning, and improved definition of treatment volumes, are still considered experimental and should be tested in specialized centers. J. Surg. Oncol. 2005;92:239–245. © 2005 Wiley‐Liss, Inc.