Neoadjuvant DCF vs . ACF for resectable oesophageal squamous cell carcinoma

Despite falling incidence rates, squamous cell carcinoma of the oesophagus (OSCC) remains a common cancer globally; in 2012 an estimated 398,000 OSCC diagnoses were made worldwide (1-3). Whereas patients with very early OSCC (≤ cT2N0) may benefit from endoscopic or surgical resection without adjunctive therapies, patients diagnosed with OSCC which is ≥ cT3 or has clinically involved lymph nodes are recommended to undergo chemotherapy Japanese Esophageal Society Guidelines or chemoradiotherapy (ESMO, NCCN Guidelines)in addition to surgery to increase the chance of cure (4-6). Data supports both neoadjuvant chemotherapy and chemoradiotherapy in OSCC, therefore regional preferences are also important in selection of neoadjuvant therapy (7-9). Additionally, as OSCC is a radiosensitive tumour, OSCC patients may alternatively be treated with definitive chemoradiotherapy without resection which results in comparable overall survival (OS) to neoadjuvant chemoradiotherapy followed by surgery (10,11). To add to this complexity, historically most oesophageal cancer trials have included both oesophageal adenocarcinoma and OSCC patients, and there are biological differences between these tumours which impact on response to therapy and prognosis (12,13). In order to define the best treatment approach for OSCC, more high quality trials containing only OSCC patients are required. Therefore, the results presented by Yamasaki et al. in Annals of Oncology provide a welcome addition to the literature (14)