The epidemiology of esophageal cancer is changing dramatically. The circles represent adenocarcinoma and the squares represent squamous cell carcinoma. The open symbols indicate white males while the closed symbols indicate African-American males. From this slide, adenocarcinoma is increasing at an alarming rate in both white males and African-American males. This quote by Dr. Kelsen in Chest describes the current role of neoadjuvant therapy in the treatment of esophageal cancer.
Surgery alone is the standard treatment for esophageal cancer.
Also, the results of some phase II studies have improved survival, but compared to historic controls and have not been verified by randomized studies. There is a long accrual time to complete randomized studies. Fourth, accurate pretreatment staging has not been available in any of the randomized studies to date. Current data reported by Dr. Lierut of Belgium does show a clear-cut stratification of survival based on radical esophagectomy pathology. The presence or absence of nodal metastases is an important predictor of survival, and while Dr. Lierut has shown that accurate staging by radical esophagectomy is possible, we do not currently have an accurate pretreatment staging modality that would allow us to better assess the effects of new neoadjuvant protocols.