open access

Vol 66, No 2 (2016)
Oncological debates
Published online: 2016-06-01
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Should inductive chemo-radiotherapy be used in locally advanced oesophageal cancer in T1b N+, T2-4a N0-N+ stages?

Grzegorz Wallner
DOI: 10.5603/NJO.2016.0026
·
Nowotwory. Journal of Oncology 2016;66(2):167-173.

open access

Vol 66, No 2 (2016)
Oncological debates
Published online: 2016-06-01

Abstract

The therapy of oesophageal tumours of epithelial origin still arouses controversy. Oesophageal cancers, regardless of whether squamous cell carcinoma, or which currently more often occurs, adenocarcinoma, both types are among the most malignant tumours of the digestive tract. Their incidence is associated with a relatively high rate of failure. They are both difficult to treat with surgery, and also with several attempts of combined therapy consisting radiotherapy and chemotherapy (RT/ChT). Despite the systematic development of knowledge, attempts of individualisation and interdisciplinary treatment of oesophageal cancers, new diagnostic techniques, technological progress of minimally invasive surgical techniques, and far better skills in post-operative care, the results of oesophageal cancer therapy permanently remain at an unsatisfactory level. In Poland, only 10–15% of cancers of the oesophagus are originally eligible for radical surgical excision. The hope to improve unfavourable long-term results in the treatment of oesophageal cancer is believed to be either in the diagnosis of early cancers, allowing the use of endoscopic methods (endoscopic mucosal resection — EMR, submucosal dissection — SMD), or cancers in a stage qualifying them for radical excision of the oesophagus (minimally invasive oesophagectomy — MIE, with open approach transhiatal or transthoracic oesophagectomy — THE/TTE), or in complex therapy of surgery and available combinations of RT with ChT. For years there has been a debate about the value of combined therapy in oesophageal cancer. The published data are often contradictory, ambiguous, criticised for large heterogenity of the clinical cases analysed and therapeutic approaches, as well as for the lack of methodological correctness. In the literature we can find the data from early publications retrospectively verifying the results of surgery, chemotherapy, and radiotherapy as independent methods, and by combining these methods. We now have the introduction of different variants of complex therapy preoperatively, and recently also perioperative radiochemotherapy (RChT), the individualisation and interdisciplinary approaches, and finally attempts of targeted therapy of oesophageal cancer. There are also changes in methodological criteria for clinical analyses. In accordance with the evidence base medicine rules currently the highest level and degree of recommendations are based on multicentre studies, prospective randomised trials (mPRCT), and also meta-analyses of mPRCT or data from large/national population databases. In line with the recommendations of scientific societies, and organisations involved in developing practical guidelines, the optimal strategy for oesophageal cancer treatment is preoperative RChT in a neoadjuvant manner followed by surgical excision of the oesophagus with two or three-field lymph nodes dissection. However, despite the qualitative improvement of methodology in cited publications, the results of oesophageal cancer therapy are still poor, and the value of the proposed therapeutic strategies is quite often questionable.

Abstract

The therapy of oesophageal tumours of epithelial origin still arouses controversy. Oesophageal cancers, regardless of whether squamous cell carcinoma, or which currently more often occurs, adenocarcinoma, both types are among the most malignant tumours of the digestive tract. Their incidence is associated with a relatively high rate of failure. They are both difficult to treat with surgery, and also with several attempts of combined therapy consisting radiotherapy and chemotherapy (RT/ChT). Despite the systematic development of knowledge, attempts of individualisation and interdisciplinary treatment of oesophageal cancers, new diagnostic techniques, technological progress of minimally invasive surgical techniques, and far better skills in post-operative care, the results of oesophageal cancer therapy permanently remain at an unsatisfactory level. In Poland, only 10–15% of cancers of the oesophagus are originally eligible for radical surgical excision. The hope to improve unfavourable long-term results in the treatment of oesophageal cancer is believed to be either in the diagnosis of early cancers, allowing the use of endoscopic methods (endoscopic mucosal resection — EMR, submucosal dissection — SMD), or cancers in a stage qualifying them for radical excision of the oesophagus (minimally invasive oesophagectomy — MIE, with open approach transhiatal or transthoracic oesophagectomy — THE/TTE), or in complex therapy of surgery and available combinations of RT with ChT. For years there has been a debate about the value of combined therapy in oesophageal cancer. The published data are often contradictory, ambiguous, criticised for large heterogenity of the clinical cases analysed and therapeutic approaches, as well as for the lack of methodological correctness. In the literature we can find the data from early publications retrospectively verifying the results of surgery, chemotherapy, and radiotherapy as independent methods, and by combining these methods. We now have the introduction of different variants of complex therapy preoperatively, and recently also perioperative radiochemotherapy (RChT), the individualisation and interdisciplinary approaches, and finally attempts of targeted therapy of oesophageal cancer. There are also changes in methodological criteria for clinical analyses. In accordance with the evidence base medicine rules currently the highest level and degree of recommendations are based on multicentre studies, prospective randomised trials (mPRCT), and also meta-analyses of mPRCT or data from large/national population databases. In line with the recommendations of scientific societies, and organisations involved in developing practical guidelines, the optimal strategy for oesophageal cancer treatment is preoperative RChT in a neoadjuvant manner followed by surgical excision of the oesophagus with two or three-field lymph nodes dissection. However, despite the qualitative improvement of methodology in cited publications, the results of oesophageal cancer therapy are still poor, and the value of the proposed therapeutic strategies is quite often questionable.

Get Citation
About this article
Title

Should inductive chemo-radiotherapy be used in locally advanced oesophageal cancer in T1b N+, T2-4a N0-N+ stages?

Journal

Nowotwory. Journal of Oncology

Issue

Vol 66, No 2 (2016)

Pages

167-173

Published online

2016-06-01

DOI

10.5603/NJO.2016.0026

Bibliographic record

Nowotwory. Journal of Oncology 2016;66(2):167-173.

Authors

Grzegorz Wallner

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