Neoadjuvant treatment of esophageal cancer: chemotherapy, chemoradiation, immunotherapy, and future trends of therapy
In the Western hemisphere, nonmetastatic locally advanced esophageal carcinoma is mostly treated in multimodal therapy protocols according to current therapy guidelines. In squamous cell carcinoma of the esophagus, neoadjuvant chemoradiation is the favorable option. Unimodal surgical and chemoradiat...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
De Gruyter
2024-11-01
|
| Series: | Innovative Surgical Sciences |
| Subjects: | |
| Online Access: | https://doi.org/10.1515/iss-2023-0005 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850060854020538368 |
|---|---|
| author | Malekzada Freschta Vladimiriov Miljana Leitz Michael Michel Julia Nimzewski Fabian Hoeppner Jens |
| author_facet | Malekzada Freschta Vladimiriov Miljana Leitz Michael Michel Julia Nimzewski Fabian Hoeppner Jens |
| author_sort | Malekzada Freschta |
| collection | DOAJ |
| description | In the Western hemisphere, nonmetastatic locally advanced esophageal carcinoma is mostly treated in multimodal therapy protocols according to current therapy guidelines. In squamous cell carcinoma of the esophagus, neoadjuvant chemoradiation is the favorable option. Unimodal surgical and chemoradiation treatment alternatives show inferior results on this entity. For locally advanced adenocarcinoma of the esophagus perioperative chemotherapy and neoadjuvant chemoradiation have been competing treatment approaches in the recent past. Both are evidence based (class I evidence) and superior compared to unimodal surgery. However, the latest results of head-to-head comparative therapy studies show superior overall survival results for the FLOT regimen of perioperative chemotherapy. Furthermore, immunotherapy and targeted therapy with monoclonal antibodies have become a strong focus of current clinical research. Nivolumab as well as trastuzumab are already an important part of the current standard therapies. In both entities – SCC and AC – a significant quota of patients shows a locoregional complete remission of the tumor in the specimen after modern neoadjuvant therapy and surgical resection. The addition of immunotherapy and targeted therapy to neoadjuvant therapy further increases complete remission rates in defined subgroups according to the results of current studies. Currently, three prospective randomized trials are ongoing on the subject of future possibilities for organ-preserving concepts in case of complete clinical remission (“surgery as needed,” “watch and wait”). It is to be expected for the future that curative short-term and long-term treatment results in locally advanced esophageal carcinoma will significantly improve, particularly due to the additional possibilities of immunotherapy and organ-preserving therapy concepts in postneoadjuvant complete remission. |
| format | Article |
| id | doaj-art-d6bb2c7c8be94c45ab0a50343378254d |
| institution | DOAJ |
| issn | 2364-7485 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | De Gruyter |
| record_format | Article |
| series | Innovative Surgical Sciences |
| spelling | doaj-art-d6bb2c7c8be94c45ab0a50343378254d2025-08-20T02:50:26ZengDe GruyterInnovative Surgical Sciences2364-74852024-11-011013910.1515/iss-2023-0005Neoadjuvant treatment of esophageal cancer: chemotherapy, chemoradiation, immunotherapy, and future trends of therapyMalekzada Freschta0Vladimiriov Miljana1Leitz Michael2Michel Julia3Nimzewski Fabian4Hoeppner Jens5Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, GermanyDepartment of Surgery, Bielefeld University, Medical School and University Medical Center OWL, Klinikum Lippe, Detmold, GermanyDepartment of Surgery, Bielefeld University, Medical School and University Medical Center OWL, Klinikum Lippe, Detmold, GermanyDepartment of Surgery, Bielefeld University, Medical School and University Medical Center OWL, Klinikum Lippe, Detmold, GermanyDepartment of Surgery, Bielefeld University, Medical School and University Medical Center OWL, Klinikum Lippe, Detmold, GermanyDepartment of Surgery, Bielefeld University, Medical School and University Medical Center OWL, Klinikum Lippe, Detmold, GermanyIn the Western hemisphere, nonmetastatic locally advanced esophageal carcinoma is mostly treated in multimodal therapy protocols according to current therapy guidelines. In squamous cell carcinoma of the esophagus, neoadjuvant chemoradiation is the favorable option. Unimodal surgical and chemoradiation treatment alternatives show inferior results on this entity. For locally advanced adenocarcinoma of the esophagus perioperative chemotherapy and neoadjuvant chemoradiation have been competing treatment approaches in the recent past. Both are evidence based (class I evidence) and superior compared to unimodal surgery. However, the latest results of head-to-head comparative therapy studies show superior overall survival results for the FLOT regimen of perioperative chemotherapy. Furthermore, immunotherapy and targeted therapy with monoclonal antibodies have become a strong focus of current clinical research. Nivolumab as well as trastuzumab are already an important part of the current standard therapies. In both entities – SCC and AC – a significant quota of patients shows a locoregional complete remission of the tumor in the specimen after modern neoadjuvant therapy and surgical resection. The addition of immunotherapy and targeted therapy to neoadjuvant therapy further increases complete remission rates in defined subgroups according to the results of current studies. Currently, three prospective randomized trials are ongoing on the subject of future possibilities for organ-preserving concepts in case of complete clinical remission (“surgery as needed,” “watch and wait”). It is to be expected for the future that curative short-term and long-term treatment results in locally advanced esophageal carcinoma will significantly improve, particularly due to the additional possibilities of immunotherapy and organ-preserving therapy concepts in postneoadjuvant complete remission.https://doi.org/10.1515/iss-2023-0005esophageal cancerchemotherapychemoradiationimmunotherapymultimodal treatment |
| spellingShingle | Malekzada Freschta Vladimiriov Miljana Leitz Michael Michel Julia Nimzewski Fabian Hoeppner Jens Neoadjuvant treatment of esophageal cancer: chemotherapy, chemoradiation, immunotherapy, and future trends of therapy Innovative Surgical Sciences esophageal cancer chemotherapy chemoradiation immunotherapy multimodal treatment |
| title | Neoadjuvant treatment of esophageal cancer: chemotherapy, chemoradiation, immunotherapy, and future trends of therapy |
| title_full | Neoadjuvant treatment of esophageal cancer: chemotherapy, chemoradiation, immunotherapy, and future trends of therapy |
| title_fullStr | Neoadjuvant treatment of esophageal cancer: chemotherapy, chemoradiation, immunotherapy, and future trends of therapy |
| title_full_unstemmed | Neoadjuvant treatment of esophageal cancer: chemotherapy, chemoradiation, immunotherapy, and future trends of therapy |
| title_short | Neoadjuvant treatment of esophageal cancer: chemotherapy, chemoradiation, immunotherapy, and future trends of therapy |
| title_sort | neoadjuvant treatment of esophageal cancer chemotherapy chemoradiation immunotherapy and future trends of therapy |
| topic | esophageal cancer chemotherapy chemoradiation immunotherapy multimodal treatment |
| url | https://doi.org/10.1515/iss-2023-0005 |
| work_keys_str_mv | AT malekzadafreschta neoadjuvanttreatmentofesophagealcancerchemotherapychemoradiationimmunotherapyandfuturetrendsoftherapy AT vladimiriovmiljana neoadjuvanttreatmentofesophagealcancerchemotherapychemoradiationimmunotherapyandfuturetrendsoftherapy AT leitzmichael neoadjuvanttreatmentofesophagealcancerchemotherapychemoradiationimmunotherapyandfuturetrendsoftherapy AT micheljulia neoadjuvanttreatmentofesophagealcancerchemotherapychemoradiationimmunotherapyandfuturetrendsoftherapy AT nimzewskifabian neoadjuvanttreatmentofesophagealcancerchemotherapychemoradiationimmunotherapyandfuturetrendsoftherapy AT hoeppnerjens neoadjuvanttreatmentofesophagealcancerchemotherapychemoradiationimmunotherapyandfuturetrendsoftherapy |