Neoadjuvant Chemoradiotherapy Improves Histological Results Compared with Perioperative Chemotherapy in Locally Advanced 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 (R0). 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. R0 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.