J.Jpn. Surg. Soc.. 112(2): 104-110, 2011

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Feature topic

NEOADJUVANT CHEMOTHERAPY FOLLOWED BY SURGERY AS STANDARD TREATMENT FOR STAGE II+III THORACIC ESOPHAGEAL SQUAMOUS CELL CARCINOMA IN JAPAN

In Japan, the overall 5-year survival rates after surgery alone for thoracic esophageal squamous cell carcinoma are 88% in patients with stage I and 52% in patients with stage II+III disease. Because of the poor outcome of stage II+III patients, multimodality approaches based on chemotherapy or chemoradiotherapy have been evaluated as adjuvant therapy. Neoadjuvant chemoradiotherapy has mainly been evaluated in the USA, while adjuvant chemotherapy for systemic effects has mainly been evaluated in Japan. In 2003, the results of a randomized study (Japan Clinical Oncology Group [JCOG] 9204) comparing surgery alone with postoperative chemotherapy with cisplatin and fluorouracil were reported, confirming that adjuvant chemotherapy prevents relapse in patients with esophageal cancer after surgery. In 2008, another study (JCOG 9907) comparing postoperative and preoperative chemotherapy was reported, and those results showed that preoperative chemotherapy induced downstaging and R0 reduction and improved overall survival without additional serious adverse events. Preoperative chemotherapy with cisplatin and fluorouracil followed by surgery can be regarded as the standard treatment for stage II+III thoracic esophageal squamous cell carcinoma in Japan.

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