Not that kind of neo.
Top Line: We know that neoadjuvant chemoradiation improves overall survival for patients with locally advanced esophageal cancer. But does it really?
The Study: The classic CROSS trial, which compared surgery alone versus carboplatin/paclitaxel with concurrent radiation to 41.4 Gy followed by surgery, showed a large improvement in rates of margin-negative resection, not to mention median overall survival (OS). But the kicker is it was very "Western," meaning 75% of patients had adenocarcinoma. Worldwide, squamous cell carcinoma (SCC) of the esophagus is the predominant histology. So these Eastern authors still consider it “controversial” whether or not the CROSS regimen applies globally...even though the pathologic complete response rate (pCR) for SCC was highest of all histologies at nearly 50%. In the Chinese NEOCRTEC5010 trial, patients with resectable stage IIB-III esophageal SCC were randomized to straight-up surgery versus neoadjuvant cisplatin/vinorelbine with concurrent radiation to 40 Gy prior to surgery. Neoadjuvant chemoradiation significantly improved median OS from over 5 → over 8 years. Where did this huge benefit come from? Probably the 43% pCR rate, significant down-staging, and an improved margin-negative resection rate. Most intriguing, even among patients with margin-negative resections, those who had neoadjuvant chemoradiation still had improved disease free survival.
Bottom Line: Neoadjuvant chemoradiation really improves survival in both adeno and squam esophageal cancer. | Yang, J Clin Oncol 2018
The Study: The classic CROSS trial, which compared surgery alone versus carboplatin/paclitaxel with concurrent radiation to 41.4 Gy followed by surgery, showed a large improvement in rates of margin-negative resection, not to mention median overall survival (OS). But the kicker is it was very "Western," meaning 75% of patients had adenocarcinoma. Worldwide, squamous cell carcinoma (SCC) of the esophagus is the predominant histology. So these Eastern authors still consider it “controversial” whether or not the CROSS regimen applies globally...even though the pathologic complete response rate (pCR) for SCC was highest of all histologies at nearly 50%. In the Chinese NEOCRTEC5010 trial, patients with resectable stage IIB-III esophageal SCC were randomized to straight-up surgery versus neoadjuvant cisplatin/vinorelbine with concurrent radiation to 40 Gy prior to surgery. Neoadjuvant chemoradiation significantly improved median OS from over 5 → over 8 years. Where did this huge benefit come from? Probably the 43% pCR rate, significant down-staging, and an improved margin-negative resection rate. Most intriguing, even among patients with margin-negative resections, those who had neoadjuvant chemoradiation still had improved disease free survival.
Bottom Line: Neoadjuvant chemoradiation really improves survival in both adeno and squam esophageal cancer. | Yang, J Clin Oncol 2018
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