Deciding on the neoadjuvant approach for esophageal adenocarcinomas

Surgery alone has long been the single most effective treatment modality for the management of esophageal cancer. However, despite modern advances in surgical techniques, the 5-year survival with surgery alone is only in the range of 16–33% (1,2). The addition of neoadjuvant therapy, whether it is neoadjuvant chemoradiotherapy (NCRT) or neoadjuvant chemotherapy (NCT), can significantly improve clinical outcomes compared with surgery alone. In studies using NCRT, a higher complete resection rate can be achieved compared to surgery (80–92% vs. 59–69%) (2,3), as well as the pathologic complete response (pCR) rate, ranging from 16% to 33% (1-4), which can be an independent favorable prognostic factor (5,6).