Neoadjuvant versus adjuvant treatment: which one is better for resectable esophageal squamous cell carcinoma?

World Journal of Surgical Oncology

Weimin Mao¹  Qixun Chen¹  Xinmin Yu²  Yaping Xu³ 

[1] Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, 310022, Zhejiang, People’s Republic of China;Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, 310022, Zhejiang, People’s Republic of China;Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, 310022, Zhejiang, People’s Republic of China

关键词: Chemoradiotherapy;    Radiotherapy;    Chemotherapy;    Adjuvant therapy;    Neoadjuvant therapy;    Squamous cell carcinoma;    Esophageal cancer;   

Others  :  827362
DOI  :  10.1186/1477-7819-10-173

 received in 2012-04-01, accepted in 2012-07-27,  发布年份 2012

【 摘 要 】

Esophageal cancer is the eighth most common cancer worldwide, and especially in some areas of China is the fourth most common cause of death and is of squamous cell carcinoma (SCC) histology in >90% of cases. Surgery alone was the mainstay of therapeutic intervention in the past, but high rates of local and systemic failure have prompted investigation into multidisciplinary management. In this review, we discuss the key issues raised by the recent availability of esophageal SCC treatment with the addition of chemotherapy, radiotherapy, and chemoradiotherapy to the surgical management of resectable disease and discuss how clinical trials and meta-analysis inform current clinical practice. None of the randomized trials that compared neoadjuvant radiotherapy or chemotherapy with surgery alone in esophageal SCC has demonstrated an increase in overall survival in those patients treated with neoadjuvant radiotherapy or chemotherapy. Neoadjuvant chemoradiotherapy has been accepted recently for esophageal cancer because such a regimen offers great opportunity for margin negative resection, improved loco-regional control and increased survival. The majority of the available evidence currently reveals that only selected locally advanced esophageal SCC are more likely to benefit from the adjuvant therapy. The focus of future trials should be on identification of the optimum regimen and should aim to minimize treatment toxicities and effect on quality of life, as well as attempt to identify and select those patients most likely to benefit from specific treatment options.

【 授权许可】

   
2012 Xu et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Bollschweiler E, Wolfgarten E, Gutschow C, Hölscher AH: Demographic variations in the rising incidence of esophageal adenocarcinoma in white males. Cancer 2001, 92:549-555.
• [2]Pohl H, Welch HG: The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst 2005, 97:142-146.
• [3]Kamangar F, Dores GM, Anderson WF: Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 2006, 24:2137-2150.
• [4]Siegel R, Naishadham D, Jemal A: Cancer statistics 2012. CA Cancer J Clin 2012, 62:10-29.
• [5]Mariette C, Finzi L, Piessen G, Van Seuningen I, Triboulet JP: Esophageal carcinoma: prognostic differences between squamous cell carcinoma and adenocarcinoma. World J Surg 2005, 29:39-45.
• [6]Hölscher AH, Bollschweiler E, Schneider PM, Siewert JR: Prognosis of early esophageal cancer. Comparison between adeno- and squamous cell carcinoma. Cancer 1995, 76:178-186.
• [7]Bollschweiler E, Metzger R, Drebber U, Baldus S, Vallböhmer D, Kocher M, Hölscher AH: Histological type of esophageal cancer might affect response to neo-adjuvant radiochemotherapy and subsequent prognosis. Ann Oncol 2009, 20:231-238.
• [8]Stein HJ, Feith M, Bruecher BL, Naehrig J, Sarbia M, Siewert JR: Early esophageal cancer: pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection. Ann Surg 2005, 242:566-573. discussion 573–575
• [9]Bollschweiler E, Schröder W, Hölscher AH, Siewert JR: Preoperative risk analysis in patients with adenocarcinoma or squamous cell carcinoma of the oesophagus. Br J Surg 2000, 87:1106-1110.
• [10]Siewert JR, Ott K: Are squamous and adenocarcinomas of the esophagus the same disease? Semin Radiat Oncol 2007, 17:38-44.
• [11]Launois B, Delarue D, Campion JP, Kerbaol M: Preoperative radiotherapy for carcinoma of the esophagus. Surg Gynecol Obstet 1981, 153:690-692.
• [12]Gignoux M, Roussel A, Paillot B, Gillet M, Schlag P, Favre JP, Dalesio O, Buyse M, Duez N: The value of preoperative radiotherapy in esophageal cancer: results of a study by the EORTC. World J Surg 1987, 11:426-432.
• [13]Arnott SJ, Duncan W, Kerr GR, Walbaum PR, Cameron E, Jack WJ, Mackillop WJ: Low dose preoperative radiotherapy for carcinoma of the oesophagus: results of a randomized clinical trial. Radiother Oncol 1992, 24:108-113.
• [14]Nygaard K, Hagen S, Hansen HS, Hatlevoll R, Hultborn R, Jakobsen A, Mäntyla M, Modig H, Munck-Wikland E, Rosengren B: Pre-operative radiotherapy prolongs survival in operable esophageal carcinoma: a randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second Scandinavian trial in esophageal cancer. World J Surg 1992, 16:1104-1109. discussion 1110
• [15]Wang M, Gu XZ, Yin WB, Huang GJ, Wang LJ, Zhang DW: Randomized clinical trial on the combination of preoperative irradiation and surgery in the treatment of esophageal carcinoma: report on 206 patients. Int J Radiat Oncol Biol Phys 1989, 16:325-327.
• [16]Arnott SJ, Duncan W, Gignoux M, Girling DJ, Hansen HS, Launois B, Nygaard K, Parmar MK, Rousell A, Spiliopoulos G, Stewart LA, Tierney JF, Wang M, Rhugang Z: Preoperative radiotherapy for esophageal carcinoma. Cochrane Database Syst Rev 2005, 4:CD001799.
• [17]Schwer AL, Ballonoff A, McCammon R, Rusthoven K, D’Agostino RB Jr, Schefter TE: Survival effect of neoadjuvant radiotherapy before esophagectomy for patients with esophageal cancer: a surveillance, epidemiology, and end-results study. Int J Radiat Oncol Biol Phys 2009, 73:449-455.
• [18]Schlag PM: Randomized trial of preoperative chemotherapy for squamous cell cancer of the esophagus. The Chirurgische Arbeitsgemeinschaft Fuer Onkologie der Deutschen Gesellschaft Fuer Chirurgie Study Group. Arch Surg 1992, 127:1446-1450.
• [19]Maipang T, Vasinanukorn P, Petpichetchian C, Chamroonkul S, Geater A, Chansawwaang S, Kuapanich R, Panjapiyakul C, Watanaarepornchai S, Punperk S: Induction chemotherapy in the treatment of patients with carcinoma of the esophagus. J Surg Oncol 1994, 56:191-197.
• [20]Law S, Fok M, Chow S, Chu KM, Wong J: Preoperative chemotherapy versus surgical therapy alone for squamous cell carcinoma of the esophagus: a prospective randomized trial. J Thorac Cardiovasc Surg 1997, 114:210-217.
• [21]Ancona E, Ruol A, Santi S, Merigliano S, Sileni VC, Koussis H, Zaninotto G, Bonavina L, Peracchia A: Only pathologic complete response to neoadjuvant chemotherapy improves significantly the long term survival of patients with resectable esophageal squamous cell carcinoma: final report of a randomized, controlled trial of preoperative chemotherapy versus surgery alone. Cancer 2001, 91:2165-2174.
• [22]Kelsen DP, Winter KA, Gunderson LL, Mortimer J, Estes NC, Haller DG, Ajani JA, Kocha W, Minsky BD, Roth JA, Willett CG: Long-term results of RTOG trial 8911 (USA Intergroup 113): a random assignment trial comparison of chemotherapy followed by surgery compared with surgery alone for esophageal cancer. J Clin Oncol 2007, 25:3719-3725.
• [23]Allum WH, Stenning SP, Bancewicz J, Clark PI, Langley RE: Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer. J Clin Oncol 2009, 27:5062-5067.
• [24]Sato M, Ando N: Neoadjuvant chemotherapy followed by surgery as standard treatment for stage II + III thoracic esophageal squamous cell carcinoma in Japan. Nihon Geka Gakkai Zasshi 2011, 112:104-110.
• [25]Ando N, Iizuka T, Ide H, Ishida K, Shinoda M, Nishimaki T, Takiyama W, Watanabe H, Isono K, Aoyama N, Makuuchi H, Tanaka O, Yamana H, Ikeuchi S, Kabuto T, Nagai K, Shimada Y, Kinjo Y, Fukuda H: Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus: a Japan Clinical Oncology Group Study – JCOG9204. J Clin Oncol 2003, 21:4592-4596.
• [26]Sjoquist KM, Burmeister BH, Smithers BM, Zalcberg JR, Simes RJ, Barbour A, Gebski V: Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol 2011, 12:681-692.
• [27]Herskovic A, Martz K, al-Sarraf M, Leichman L, Brindle J, Vaitkevicius V, Cooper J, Byhardt R, Davis L, Emami B: Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med 1992, 326:1593-1598.
• [28]Overgaard J: Hypoxic radiosensitization: adored and ignored. J Clin Oncol 2007, 25:4066-4074.
• [29]Albertsson M: Chemoradiotherapy of esophageal cancer. Acta Oncol 2002, 41:118-123.
• [30]Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D, Lozach P, Ollier JC, Pavy JJ, Mercier M, Sahmoud T: Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 1997, 337:161-167.
• [31]Mariette C, Seitz JF, Maillard E: Impact of neoadjuvant chemoradiation in localized esophageal cancer: results of a randomized, controlled phase III trial. FFCD 9901 [abstract 8000]. In Proceedings of the 35th ESMO Congress.  , Milan; 2010.
• [32]Lee JL, Park SI, Kim SB, Jung HY, Lee GH, Kim JH, Song HY, Cho KJ, Kim WK, Lee JS, Kim SH, Min YI: A single institutional phase III trial of preoperative chemotherapy with hyperfractionation radiotherapy plus surgery versus surgery alone for resectable esophageal squamous cell carcinoma. Ann Oncol 2004, 15:947-954.
• [33]Natsugoe S, Okumura H, Matsumoto M, Uchikado Y, Setoyama T, Yokomakura N, Ishigami S, Owaki T, Aikou T: Randomized controlled study on preoperative chemoradiotherapy followed by surgery versus surgery alone for esophageal squamous cell cancer in a single institution. Dis Esophagus 2006, 19:468-472.
• [34]Burmeister BH, Smithers BM, Gebski V, Fitzgerald L, Simes RJ, Devitt P, Ackland S, Gotley DC, Joseph D, Millar J, North J, Walpole ET, Denham JW: Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial. Lancet Oncol 2005, 6:659-668.
• [35]Tepper J, Krasna MJ, Niedzwiecki D, Hollis D, Reed CE, Goldberg R, Kiel K, Willett C, Sugarbaker D, Mayer R: Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol 2008, 26:1086-1092.
• [36]Gaast AV, van Hagen P, Hulshof M, Richel D, van Berge Henegouwen MI, Nieuwenhuijzen GA, Plukker JT, Bonenkamp JJ, Steyerberg EW, Tilanus HW: Esophagogastric junction cancer: results from a multicenter randomized phase III study [abstract]. J Clin Oncol 2010, 28:4004.
• [37]Kranzfelder M, Schuster T, Geinitz H, Friess H, Büchler P: Meta-analysis of neoadjuvant treatment modalities and definitive non-surgical therapy for oesophageal squamous cell cancer. Br J Surg 2011, 98:768-783.
• [38]Akutsu Y, Matsubara H, Shuto K, Uesato M, Mori M, Hoshino I, Shiratori T, Miyazawa Y, Ito H, Uno T: Clinical and pathologic evaluation of the effectiveness of neoadjuvant chemoradiation therapy in advanced esophageal cancer patients. World J Surg 2009, 33:1002-1009.
• [39]Kunath U, Fischer P: Radical nature and life expectancy in the surgical treatment of esophageal and cardial carcinoma. Dtsch Med Wochenschr 1984, 109:450-453.
• [40]Ténière P, Hay JM, Fingerhut A, Fagniez PL: Postoperative radiation therapy does not increase survival after curative resection for squamous cell carcinoma of the middle and lower esophagus as shown by a multicenter controlled trial. French University Association for Surgical Research. Surg Gynecol Obstet 1991, 173:123-130.
• [41]Fok M, Sham JS, Choy D, Cheng SW, Wong J: Postoperative radiotherapy for carcinoma of the esophagus: a prospective, randomized controlled study. Surgery 1993, 113:138-147.
• [42]Zieren HU, Müller JM, Jacobi CA, Pichlmaier H, Müller RP, Staar S: Adjuvant postoperative radiation therapy after curative resection of squamous cell carcinoma of the thoracic esophagus: a prospective randomized study. World J Surg 1995, 19:444-449.
• [43]Xiao ZF, Yang ZY, Liang J, Miao YJ, Wang M, Yin WB, Gu XZ, Zhang DC, Zhang RG, Wang LJ: Value of radiotherapy after radical surgery for esophageal carcinoma: a report of 495 patients. Ann Thorac Surg 2003, 75:331-336.
• [44]Malthaner RA, Wong RK, Rumble RB, Zuraw L: Neoadjuvant or adjuvant therapy for resectable esophageal cancer: a systematic review and meta-analysis. BMC Med 2004, 2:35-52. BioMed Central Full Text
• [45]Chen J, Zhu J, Pan J, Zhu KS, Zheng XW, Chen MQ, Wang JZ, Liao ZX: Postoperative radiotherapy improved survival of poor prognostic squamous cell carcinoma esophagus. Ann Thorac Surg 2010, 90:435-442.
• [46]Pouliquen X, Levard H, Hay JM, McGee K, Fingerhut A, Langlois-Zantin O: 5-Fluorouracil and cisplatin therapy after palliative surgical resection of squamous cell carcinoma of the esophagus. A multicenter randomized trial. French Associations for Surgical Research. Ann Surg 1996, 223:127-133.
• [47]Ando N, Iizuka T, Kakegawa T, Lsono K, Watanabe H, Lde H, Tanaka O, Shinoda M, Takiyama W, Arimori M, Lshida K, Tsugane S: A randomized trial of surgery with and without chemotherapy for localized squamous carcinoma of the thoracic esophagus: the Japan Clinical Oncology Group Study. J Thorac Cardiovasc Surg 1997, 114:205-209.
• [48]Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, Haller DG, Ajani JA, Gunderson LL, Jessup JM, Martenson JA: Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001, 345:725-730.
• [49]Tachibana M, Yoshimura H, Kinugasa S, Shibakita M, Dhar DK, Ueda S, Fujii T, Nagasue N: Postoperative chemotherapy vs chemoradiotherapy for thoracic esophageal cancer: a prospective randomized clinical trial. Eur J Surg Oncol 2003, 29:580-587.
• [50]Jin HL, Zhu H, Ling TS, Zhang HJ, Shi RH: Neoadjuvant chemoradiotherapy for resectable esophageal carcinoma: a meta-analysis. World J Gastroenterol 2009, 15:5983-5991.
• [51]National Comprehensive Cancer Network practice guidelines in Oncology. Version 2 http://www.nccn.org/professionals/physician_gls/f_guidelines.asp webcite
• [52]Ajani JA, Fodor MB, Tjulandin SA, Moiseyenko VM, Chao Y, Cabral Filho S, Majlis A, Assadourian S, Van Cutsem E: Phase II multi-institutional randomized trial of docetaxel plus cisplatin with or without fluorouracil in patients with untreated, advanced gastric, or gastroesophageal adenocarcinoma. J Clin Oncol 2005, 23:5660-5667.
• [53]Van Cutsem E, Moiseyenko VM, Tjulandin S, Majlis A, Constenla M, Boni C, Rodrigues A, Fodor M, Chao Y, Voznyi E, Risse ML, Ajani JA: Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol 2006, 24:4991-4997.
• [54]Kim JY, Do YR, Park KU, Kim MK, Lee KH, Bae SH, Ryoo HM, Baek JH, Song HS: A multi-center phase II study of docetaxel plus cisplatin as first-line therapy in patients with metastatic squamous cell esophageal cancer. Cancer Chemother Pharmacol 2010, 66:31-36.
• [55]Yoshida T, Seike J, Miyoshi T, Yamai H, Takechi H, Yuasa Y, Furukita Y, Yamamoto Y, Umemoto A, Tangoku A: Preoperative chemotherapy with weekly docetaxel plus low-dose cisplatin and 5-fluorouracil for stage II/III squamous cell carcinoma of the esophagus. Esophagus 2010, 7:95-100.