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 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 %) and was more frequent in the CRT group (94 .6 vs . 75 .4 %; p = 0 .010 ). pCR was observed in 13 patients (11 .2 %) and was more frequent in the CRT group (20 vs . 3 .3 %; p = 0 .011 ). OS was comparable between the CRT and PCT groups (41 vs . 45 months ; p = 0 .284 ). DFS was comparable between the CRT and PCT groups (21 vs . 36 months ; p = 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 .