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Comment & Response
September 22, 2021

Selection of Neoadjuvant Treatment Arms in Trials of Patients With Squamous Cell Cancer of the Esophagus—Reply

Author Affiliations
  • 1Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
JAMA Surg. 2022;157(1):84-85. doi:10.1001/jamasurg.2021.4533

In Reply We thank Trikalinos et al very much for their comments. First, we agree that the strong position of neoadjuvant chemoradiation followed by surgery has been well established by the Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS)1 and others. Meanwhile, the effect of neoadjuvant chemotherapy followed by surgery is also proved by several trials.2,3 However, which neoadjuvant approach is better for advanced esophageal cancer? There were only 3 randomized clinical trials directly comparing neoadjuvant chemoradiation vs neoadjuvant chemotherapy available at that time. Moreover, the cases in these 3 studies were all or predominantly adenocarcinoma located in the distal esophagus or esophagogastric junction. Therefore, the optimal neoadjuvant approach for the advanced esophageal squamous cell carcinoma remains to be uncertain at that time. Meanwhile, our retrospective study4 discovered that patients with local advanced esophageal squamous cell carcinoma who underwent neoadjuvant chemoradiation followed by surgery had similar mortality and morbidity as well as better long-term overall survival than neoadjuvant chemotherapy. To further critically validate this finding, we launched this prospective multicenter randomized controlled clinical trial.

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