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• W1981508747 abstract "We congratulate Ian Geh et al. [ [1] Geh I.J. Bond S.J. Bentzen S.M. Robert G.-J. Systemic overview of preoperative chemoradiotherapy trials in oesophageal cancer: evidence of a radiation and chemotherapy dose response. Radiother Oncol. 2006; 78: 236-244 Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar ] for their commendable efforts in bringing out such an article on a highly debatable issue. The article highlights the importance of pathological complete response (pCR) in predicting outcome in patients receiving preoperative chemoradiotherapy and surgery. The article also discusses hitherto unknown factors predicting pathological complete response. The authors found that dose–response relationship exists between increasing radiotherapy (RT) dose, cisplatin and 5 FU dose, median age of the patient and radiotherapy treatment time and pCR. As already accepted by the authors, a lot of assumptions have been made in the review perhaps because of it being based on published literature and not on individual patient data, and also given the fact that there is a lot of heterogeneity in this and a lot of missing evidence. Although we accept that the results of this study are very encouraging for proponents of preoperative chemoradiotherapy, we would beg to differ on a few aspects. (1)The authors accept that different radiotherapy doses and fractionations have been used however they have not made mention of the way in which radiotherapy doses were equated or compared. We are not sure whether the authors have used biological equivalent dose calculations, using Linear Quadratic model for the same. Trials by Walsh et al. [ [2] Walsh T. Noonan N. Hollywood D. Kelly A. Keeling N. Hennessey T.P.J. A comparison of multimodal therapy and surgery for oesophageal adenocarcinoma. N Engl J Med. 1996; 335: 462-467 Crossref PubMed Scopus (1811) Google Scholar ] and Bosset et al. [ [3] Bosset J.-F. Gignoux M. Triboulet J.-P. et al. Chemoradiotherapy followed by surgery compared with surgery alone in squamous cell cancer of esophagus. N Engl J Med. 1997; 337: 161-167 Crossref PubMed Scopus (1267) Google Scholar ] have used hypofractionated regimens (40Gy/15#/21 days and 37Gy/10#/28 days, respectively) while others have used conventional fractionation. A few of the studies have also incorporated planned gap in between two phases of radiotherapy [ [3] Bosset J.-F. Gignoux M. Triboulet J.-P. et al. Chemoradiotherapy followed by surgery compared with surgery alone in squamous cell cancer of esophagus. N Engl J Med. 1997; 337: 161-167 Crossref PubMed Scopus (1267) Google Scholar ]. Hence, with so many variations there is a need to convert these doses to biological equivalent doses with appropriate corrections for gaps which were either planned or unplanned to determine the efficacy of RT dose and compare the results of trials. (2)The authors have ignored all other chemotherapeutic drugs except cisplatin, 5 FU and mitomycin C given simultaneously with radiotherapy and assumed that these had zero contribution to pCR. In fact several phase II studies [ 4 Wright C.D. Wain J.C. Lynch T.J. et al. Induction therapy for esophageal cancer with paclitaxel and hyperfractionated radiotherapy: a phase I and II study. J Thorac Cardiovasc Surg. 1997; 114: 811-815 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar , 5 Meluch A.A. Greco F.A. Gray J.R. et al. Preoperative therapy with concurrent paclitaxel/carboplatin/infusional 5-FU and radiation therapy in locoregional esophageal cancer: final results of a Minnie Pearl Cancer Research Network phase II trial. Cancer J. 2003; 9: 251-260 Crossref Scopus (105) Google Scholar , 6 Khushalani K.I. Leichman C.G. Proulx G. et al. Oxaliplatin in combination with protracted-infusion fluorouracil and radiation: report of a clinical trial for patients with esophageal cancer. J Clin Oncol. 2002; 20: 2844-2850 Crossref PubMed Scopus (112) Google Scholar ] of newer chemotherapeutic agents have shown better and sustained pathological complete response rates and to ignore their contribution would not be entirely correct. (3)The authors have not included the variations in scheduling or sequencing of chemotherapeutic agents with radiotherapy as well as considered planned doses instead of actually administered doses. Although authors accept the above-mentioned facts, we feel that these are important confounding factors that cannot be ignored. And it is not appropriate to conclude that chemotherapy dose–response relation with pCR exists without an in-depth analysis of these factors." @default.
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• W1981508747 title "Systematic overview of preoperative chemoradiation trials in esophageal cancer: In response to article by Ian Geh et al." @default.
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• W1981508747 doi "https://doi.org/10.1016/j.radonc.2006.11.003" @default.
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