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• W2093151746 abstract "The question of the role of neoadjuvant chemoradiation in cT2N0 esophageal cancer (EC) published by Zhang and colleagues [1Zhang J.Q. Hooker C.M. Brock M.V. et al.Neoadjuvant chemoradiation therapy is beneficial for clinical stage T2N0 esophageal cancer patients due to inaccurate preoperative staging.Ann Thorac Surg. 2012; 93: 429-437Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar] is of major importance because it highlights both problems related to tumoral staging quality and the effects of neoadjuvant treatment on prognosis. However, some qualifications need to be made regarding some inaccuracies in the author's comments.First, the authors assert that conflicting results in the literature stem from the fact that only observational cohort studies and not randomized trials have been conducted. However, they reference a randomized trial presented orally at the 2010 American Society of Clinical Oncology meeting reporting the results of the effects of neoadjuvant chemoradiation over surgery alone in stage I and II ECs [2Mariette C. Seitz J.F. Maillard E. et al.Surgery alone versus chemoradiotherapy followed by surgery for localized esophageal cancer: analysis of a randomized controlled trial FFCD 9901.J Clin Oncol. 2010; 28 (abstr 4005)Google Scholar]. Of interest in this phase III trial, even if a number of patients have been either under or overstaged (despite systematic use of computed tomographic scanning and endoscopic ultrasonography), neoadjuvant chemoradiation failed to exhibit any survival benefit (median survival of 31.8 versus 44.5 months [p = 0.68], respectively). In addition, it was found to be responsible for a higher postoperative mortality rate compared with surgery alone (7.1% versus 1.1%; p = 0.054). This finding underlines three important issues: (1) neoadjuvant chemoradiation is not the appropriate therapy for stage I or II EC, because it does not increase R0 resection rate, decrease the risk of recurrence, or improve overall survival; (2) irrespective of the pTNM stage no survival benefit was found, suggesting that understaging is not a major problem in such tumors; and (3) chemoradiation has a deleterious effect on postoperative course. This leads to a second comment on the study by Zhang and colleagues [1Zhang J.Q. Hooker C.M. Brock M.V. et al.Neoadjuvant chemoradiation therapy is beneficial for clinical stage T2N0 esophageal cancer patients due to inaccurate preoperative staging.Ann Thorac Surg. 2012; 93: 429-437Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar]: their comments and conclusion are based on the unclear effect on neoadjuvant therapy. This leads to some confusion over the role of neoadjuvant therapy in EC, because the authors studied only the effects on neoadjuvant chemoradiation and not the role of neoadjuvant chemotherapy without radiotherapy. Most randomized studies evaluating neoadjuvant chemotherapy in EC exhibit a significant, even if small, survival benefit without any negative effect on postoperative course. In other words, neoadjuvant chemotherapy may be a therapy to be combined with surgery with a significant effect on survival for stage I or II ECs. This strategy avoids any detrimental effect on postoperative course and offers a significant decrease in metastatic recurrence, the occurrence of which is mostly linked to death [3Mariette C. Piessen G. Briez N. Gronnier C. Triboulet J.P. Oesophagogastric junction adenocarcinoma: which therapeutic approach?.Lancet Oncol. 2011; 12: 296-305Abstract Full Text Full Text PDF PubMed Scopus (142) Google Scholar]. The question of the role of neoadjuvant chemoradiation in cT2N0 esophageal cancer (EC) published by Zhang and colleagues [1Zhang J.Q. Hooker C.M. Brock M.V. et al.Neoadjuvant chemoradiation therapy is beneficial for clinical stage T2N0 esophageal cancer patients due to inaccurate preoperative staging.Ann Thorac Surg. 2012; 93: 429-437Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar] is of major importance because it highlights both problems related to tumoral staging quality and the effects of neoadjuvant treatment on prognosis. However, some qualifications need to be made regarding some inaccuracies in the author's comments. First, the authors assert that conflicting results in the literature stem from the fact that only observational cohort studies and not randomized trials have been conducted. However, they reference a randomized trial presented orally at the 2010 American Society of Clinical Oncology meeting reporting the results of the effects of neoadjuvant chemoradiation over surgery alone in stage I and II ECs [2Mariette C. Seitz J.F. Maillard E. et al.Surgery alone versus chemoradiotherapy followed by surgery for localized esophageal cancer: analysis of a randomized controlled trial FFCD 9901.J Clin Oncol. 2010; 28 (abstr 4005)Google Scholar]. Of interest in this phase III trial, even if a number of patients have been either under or overstaged (despite systematic use of computed tomographic scanning and endoscopic ultrasonography), neoadjuvant chemoradiation failed to exhibit any survival benefit (median survival of 31.8 versus 44.5 months [p = 0.68], respectively). In addition, it was found to be responsible for a higher postoperative mortality rate compared with surgery alone (7.1% versus 1.1%; p = 0.054). This finding underlines three important issues: (1) neoadjuvant chemoradiation is not the appropriate therapy for stage I or II EC, because it does not increase R0 resection rate, decrease the risk of recurrence, or improve overall survival; (2) irrespective of the pTNM stage no survival benefit was found, suggesting that understaging is not a major problem in such tumors; and (3) chemoradiation has a deleterious effect on postoperative course. This leads to a second comment on the study by Zhang and colleagues [1Zhang J.Q. Hooker C.M. Brock M.V. et al.Neoadjuvant chemoradiation therapy is beneficial for clinical stage T2N0 esophageal cancer patients due to inaccurate preoperative staging.Ann Thorac Surg. 2012; 93: 429-437Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar]: their comments and conclusion are based on the unclear effect on neoadjuvant therapy. This leads to some confusion over the role of neoadjuvant therapy in EC, because the authors studied only the effects on neoadjuvant chemoradiation and not the role of neoadjuvant chemotherapy without radiotherapy. Most randomized studies evaluating neoadjuvant chemotherapy in EC exhibit a significant, even if small, survival benefit without any negative effect on postoperative course. In other words, neoadjuvant chemotherapy may be a therapy to be combined with surgery with a significant effect on survival for stage I or II ECs. This strategy avoids any detrimental effect on postoperative course and offers a significant decrease in metastatic recurrence, the occurrence of which is mostly linked to death [3Mariette C. Piessen G. Briez N. Gronnier C. Triboulet J.P. Oesophagogastric junction adenocarcinoma: which therapeutic approach?.Lancet Oncol. 2011; 12: 296-305Abstract Full Text Full Text PDF PubMed Scopus (142) Google Scholar]." @default.
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• W2093151746 title "Impact of Neoadjuvant Chemoradiation in Early Esophageal Cancers" @default.
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