Neoadjuvant treatment in oesophageal cancer: the needs for future trials

In view of the poor survival after surgery alone for oesophageal cancer, combination with chemotherapy seems rational. A concept of upfront chemotherapy is discussed and seems especially useful for these tumours. The published randomized trials, studying the effect of neoadjuvant chemotherapy do, however, not (yet) show an improved overall survival, apart from one study with a significant median survival benefit at an interim evaluation. The responding patients have in all trials a far better survival than the non-responders. The numbers of patients are small and results of other ongoing and future trials should be awaited. New trials testing high-dose chemotherapy with bone marrow support should be initiated.