Guidelines for diagnosis and treatment of carcinoma of the esophagus: April 2007 edition: Part II edited by the Japan Esophageal Society

Preoperative chemotherapy: there have been three reports of meta-analyses based on randomized controlled trials carried out in Europe or North America that compared surgical resection with preoperative chemotherapy and surgical resection alone. However, the conclusions are conflicting: one found that preoperative chemotherapy does not improve 1-year and 2-year survival rates, whereas the other showed preoperative chemotherapy to slightly improve the 2-year survival rate. At present, the efficacy of preoperative chemotherapy for resectable cases (T1-3, N0,1, M0; 2002 edition of UICC classification) is unclear. Preoperative chemoradiotherapy: the results of a meta-analysis of randomized controlled trials comparing surgery alone and surgery combined with preoperative chemoradiotherapy carried out in Europe and North America showed that preoperative concurrent chemoradiotherapy (20-45 Gy) for resectable cases (T1-3, N0,1, M0) caused a significant increase in operation-related mortality while significantly improving the 3-year survival rate. However, when the 1-year or 2-year survival rate was the endpoint, there was no clear survival benefit of preoperative chemoradiotherapy. Thus, the results of this meta-analysis of randomized controlled trials performed in Europe and North America suggest that preoperative chemoradiotherapy combined with surgery has the potential to improve the long-term survival of patients undergoing surgical resection of esophageal carcinoma. In Japan, this therapy is performed for locally advanced cases in a number of institutions. However, no high-level evidence is available concerning Japanese patients, and there is no firm basis for recommending the use of preoperative chemoradiotherapy in Japan.