Thoughts on prediction of pathological response and strategies of esophageal preservation in the era of neoadjuvant therapy for esophageal cancer

Abstract

In recent years, neoadjuvant treatment followed by esophagectomy has been the standard treatment strategy for locally advanced esophageal cancer. Pathological response, especially complete pathological response (pCR), indicates better overall survival. With respect to complete clinical response (cCR) after neoadjuvant treatment, some researchers propose that definitive chemoradiotherapy could be an alternative to esophagectomy. The authors analyze and summarize correlation between cCR and pCR, and survival benefits of watch and wait after cCR. The authors think cCR alone could not be the precondition for the debate, unless combined with an effective predition of pCR based on clinical and molecular biomarkers. In this way, a prudent selection of patients followed by optimal therapy could be an important direction of individual management for locally advanced esophageal cancer. Key words: Esophageal neoplasms; Esophageal cancer; Neoadjuvant therapy; Surgical treatment; Complete pathological response; Complete clinical response