Oesophageal cancer: preoperative chemotherapy.

The optimal management of localised oesophageal cancer remains controversial. Indeed, currently utilised strategies are clearly unsatisfactory, given that most randomised trials report overall 5-year survivals of 20% or less for patients undergoing surgical resection. The rationale behind preoperative chemotherapy is two-fold: (i) to downstage or downsize the primary tumour in order to ensure complete surgical resection; and (ii) to pre-emptively destroy any distant foci of micrometastatic disease. This preoperative chemotherapy paradigm is increasingly being used in a number of other areas in gastrointestinal oncology, but has yet to become generally accepted for oesophageal cancer. The current issues that need to be addressed include the fundamental question of whether preoperative chemotherapy is superior to surgery alone; identification of the optimal chemotherapy regimen; defining the optimal duration of preoperative chemotherapy; and assessing tumour response to such therapy. This article will address these issues, focusing on preoperative and perioperative chemotherapy approaches to the management of localised adenocarcinomas and squamous cell carcinomas (SCC) of the oesophagus and oesophago-gastric junction (EGJ).