Pre- and postoperative treatment modalities for esophageal squamous cell carcinoma.

BACKGROUND The objective of this article was to review randomized clinical trials (RCTs) utilizing pre- and postoperative treatment modalities for esophageal squamous cell carcinoma (ESCC). MATERIALS AND METHODS A computerized (MEDLINE) and manual search was performed to identify articles published on this topic between 1984 and 2012. RESULTS We identified a total of 49 published RCTs, which included a total of 8,785 patients with ESCC. Treatment modalities consisted of pre- (n=38) and postoperative (n=11) chemo-, radio- and chemoradiotherapy. While both preoperative chemotherapy and chemoradiotherapy apparently improve R0 resection, they often result in substantial postoperative morbidity and mortality. Only for preoperative chemoradiotherapy does there seem to be a significant benefit in overall survival. CONCLUSION R0 resection remains the only curative therapy for patients with ESCC. While preoperative chemoradiotherapy may improve overall survival, there is still the need for well-designed RCTs, which should include a homogeneous patient collective, to clarify the question of definitive benefit.