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Adapted from the NCI Cancer Bulletin, vol. 4/no. 10, March 6, 2007 (see the current issue ³).

A significant survival benefit was evident for the preoperative (neoadjuvant) use of combination chemoradiotherapy and, to a lesser extent, for chemotherapy alone in patients with localized esophageal cancer in a meta-analysis of data from numerous clinical trials that was published in the March 2007 Lancet Oncology (see the journal abstract ⁴).

Traditional management of patients with localized esophageal cancer has been by surgical resection alone; however, "survival is poor...and many patients develop metastatic disease or locoregional recurrence soon after surgery," noted the researchers, led by Dr. Val Gebski of the National Health and Medical Research Council Clinical Trials Centre at the University of Sydney in Australia. Because of the high rate of surgical complications, "focus has turned to neoadjuvant treatment" as a way to improve survival, they added.

The meta-analysis included 10 randomized comparisons of neoadjuvant chemoradiotherapy versus surgery alone (1,209 patients) and eight studies of neoadjuvant chemotherapy versus surgery in 1,724 patients.

Results for chemoradiotherapy studies showed a 13-percent absolute improvement in survival at two years, with similar results for different tumor types: squamous cell carcinoma (SCC) and adenocarcinoma. Analysis of the neoadjuvant chemotherapy studies indicated a 2-year absolute survival benefit of 7 percent. Chemotherapy had no significant effect on all-cause mortality for patients with SCC, although there was a significant benefit for those with adenocarcinoma.

Most of the studies included in the meta-analysis were started before 1994. "[C]urrent trials have used higher doses of radiation (typically 50 Gy) that are likely to result in better downstaging of overt tumours as well as death of micrometastases," the researchers added.

Glossary Terms

Cancer that begins in cells that line certain internal organs and that have gland-like (secretory) properties.

Treatment that combines chemotherapy with radiation therapy. Also called chemoradiation.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.

Treatment given as a first step to shrink a tumor before the main treatment, which is usually surgery, is given. Examples of neoadjuvant therapy include chemotherapy, radiation therapy, and hormone therapy. It is a type of induction therapy.

A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial.

Cancer that has recurred (come back), usually after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body. Also called recurrent cancer.

Surgery to remove tissue or part or all of an organ.

In statistics, describes a mathematical measure of difference between groups. The difference is said to be significant if it is greater than what might be expected to happen by chance alone. Also called statistically significant.

Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma.