Preoperative (Neoadjuvant) Chemotherapy in Squamous Cell Cancer of the Esophagus
Even after radical tumor resection less than 15% of the patients with esophageal cancer are alive 5 years after surgery [2, 4, 5]. Moreover, local tumor removal is possible only in some of the patients. There have been many efforts to search for ways of improving the treatment results in esophageal cancer . These include surgical techniques [11, 14] as well as combined treatment modalities [3, 8, 15]. Nevertheless, the results obtained have been rather negative. This is due to a still high percentage of primarily unresectable tumors, early metastases, and a high local relapse rate. Preoperative chemotherapy seems to be a promising new strategy [13, 16]. The objective of neoadjuvant chemotherapy is to bring about tumor regression and thereby improve resectability. The risk of tumor spread during surgery should also be decreased by devitalization of the tumor cells. Already existing micrometastases, which cause metastases later on, should be destroyed as well. Even if the theoretical aspects of this therapy seem very attractive, the question remains whether this kind of treatment is feasible at all in patients with cancer of the esophagus. On the one hand, these patients mostly suffer multimorbidity and so may not tolerate this approach. On the other hand, it has to be taken into consideration that short- or long-term side effects of preoperative chemotherapy may impair surgery. In the following report we therefore present our own experiences with a phase-II study evaluating preoperative chemotherapy in esophageal cancer. By comparing these results with those reported in the literature it should be possible to clarify the current impact of this treatment modality for the primary therapy of esophageal cancer.
KeywordsEsophageal Cancer Preoperative Chemotherapy Minor Response Combine Treatment Modality Geal Cancer
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