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Neoadjuvant Chemoradiotherapy Improves Histological Results Compared with Perioperative Chemotherapy in Locally Advanced Esophageal Adenocarcinoma.
[esophageal adenocarcinoma]
Neoadjuvant
treatment
is
considered
the
standard
treatment
for
locally
advanced
adenocarcinoma
of
the
esophagus
.
This
study
compared
the
effectiveness
of
neoadjuvant
chemoradiotherapy
(
CRT
)
and
perioperative
chemotherapy
(
PCT
)
based
on
postoperative
results
and
long
-term
survival
.
All
patients
with
locally
advanced
adenocarcinoma
of
the
esophagus
were
treated
with
a
single
protocol
of
neoadjuvant
CRT
(
cisplatin
and
5
-
fluorouracil
[
5
-
FU
]
with
45
Â
Gy
of
concurrent
radiotherapy
)
or
with
a
single
protocol
of
PCT
(
docetaxel
,
cisplatin
,
5
-
FU
)
.
The
responses
to
CRT
and
PCT
were
evaluated
by
considering
the
rates
of
pathologic
complete
response
(
pCR
)
and
radical
resection
(
R
0
)
.
Overall
survival
(
OS
)
,
disease-free
survival
(
DFS
)
,
and
recurrence
were
evaluated
according
to
the
neoadjuvant
treatment
.
A
total
of
116
patients
underwent
CRT
or
PCT
followed
by
esophagectomy
;
61
patients
underwent
PCT
,
and
55
patients
underwent
CRT
.
R
0
was
achieved
in
98
patients
(
84
.
5
Â
%
)
and
was
more
frequent
in
the
CRT
group
(
94
.
6
vs
.
75
.
4
Â
%
;
p
Â
=
Â
0
.
010
)
.
pCR
was
observed
in
13
patients
(
11
.
2
Â
%
)
and
was
more
frequent
in
the
CRT
group
(
20
vs
.
3
.
3
Â
%
;
p
Â
=
Â
0
.
011
)
.
OS
was
comparable
between
the
CRT
and
PCT
groups
(
41
vs
.
45
Â
months
;
p
Â
=
Â
0
.
284
)
.
DFS
was
comparable
between
the
CRT
and
PCT
groups
(
21
vs
.
36
Â
months
;
p
Â
=
Â
0
.
522
)
.
In
this
study
,
better
histological
results
were
observed
in
patients
who
had
been
treated
with
CRT
,
although
similar
survival
rates
were
observed
for
patients
treated
with
either
CRT
or
PCT
.
Further
study
is
necessary
to
select
patients
who
will
benefit
most
from
CRT
or
PCT
.
Diseases
Validation
Diseases presenting
"overall survival"
symptom
cholangiocarcinoma
congenital diaphragmatic hernia
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
hodgkin lymphoma, classical
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