Critical Care Medicine-Gastrointestinal, Nutrition and Genitourinary Disorders>>>>>Esophagus
Question 2#

A 70-year-old woman undergoes upper endoscopy, which reveals a distal esophageal mass. Biopsy of the mass confirms adenocarcinoma with invasion into the mucularis propria. Whole body PET scan shows the distal esophageal mass with no lymphadenopathy and no distal metastases.

Which statement regarding treatment with chemoradiation therapy is most correct for this patient?

A. Preoperative chemoradiation increases postoperative mortality
B. Preoperative chemoradiation before surgical resection improves survival compared to surgery alone
C. Preoperative radiation in addition to chemotherapy improves survival
D. Preoperative chemoradiation commonly results in esophageal perforation

Correct Answer is C


Correct Answer: C

Esophageal adenocarcinoma (EA) is a highly lethal disease with a 5-year survival rate of approximately 10%. The ideal timing, treatment sequence, and dose of therapy remain an active area of investigation and controversy. Multiple studies have shown improved outcomes with the addition of neoadjuvant chemoradiation before surgical resection. This form of treatment has now become the standard approach in Europe and the United States for patients with locally advanced disease such as this patient with stage II disease (T2, N0, M0).

No current studies have definitively shown that the addition of radiation to chemotherapy improves overall survival over chemotherapy alone. Chemotherapy and radiation are each active against different forms of the cancer cell population with chemotherapy most effective against micrometastatic disease and radiation targeting the locoregional tumor mass. Esophageal perforation is a rare event after neoadjuvant chemoradiation occurring in less than 0.5% of patients evaluated.


  1. Van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junction cancer. N Engl J Med. 2012;366:2074-2084.
  2. Shapiro J, van Lanschot JJB, Hulshhof MCCM, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for esophageal or junctional cancer (CROSS): long-term results of a randomized controlled trial. Lancet Oncol. 2015;16:1090-1098.
  3. Swisher SG, Hofstetter W, Komaki R, et al. Improved long-term outcome with chemoradiotherapy strategies in esophageal cancer. Ann Thorac Surg. 2010;90:892-898; discussion 898-9.