Adjuvant chemotherapy for poor pathologic response after pre-operative chemoradiation in esophageal cancer: infeasible and illogical

While recent decades have seen incremental improvements in the treatment of esophageal carcinoma, outcomes remain modest. The five-year overall survival (OS) rate for locally advanced esophageal cancer with surgery alone is 23–33% in contemporary studies (1-3). In locally advanced esophageal cancer, the risk of incomplete (R1) resection, local recurrence and systemic dissemination is significant. Numerous studies have demonstrated that the addition of chemotherapy and/or radiation to surgery improve outcomes, leading to multimodal treatment becoming standard-of-care. In particular, pre-operative chemoradiation has emerged as a standard-of-care in the US and Western Europe (4).