NEJM: neoadjuvant CTRT for esophageal cancer

NEJM this week

Dutch investigators publish a randomized phase III trial looking at carbo-taxol+RT followed by surgery vs surgery alone for esophageal/GEJ cancers: they confirm a survival benefit to combined modality for both squams and adenos.  While prior studies did show a benefit (the Walsh trial and the CALGB trial) both had low numbers and other concerns (such as the low survival in the surgery alone arm of the Walsh trial).  This will hopefully close the book on surgery alone for all but the most early stages of disease.  There still remains the question of whether the RT is adding anything to this (there are the perioperative chemo alone trials from the UK which are also positive), but for now it seems the weight of data is clearly towards multimodal treatment for this aggressive disease.

Link to NEJM

Preoperative Chemoradiotherapy for Esophageal or Junctional Cancer: New England Journal of Medicine, Volume 366, Issue 22, Page 2074-2084, May 2012.