Oesophageal
cancer is the eighth most common
cancer diagnosed worldwide, with almost half a million new cases diagnosed each year. Despite improvements in surgical and
radiotherapy techniques and refinements of chemotherapeutic regimens, long-term survival, even from localized oesophageal
cancer, remains poor. Surgical resection alone remains the standard approach for very early stage disease (stage I), but whilst surgery remains fundamental to the treatment of stage II-III resectable
adenocarcinoma, multimodality
therapy with
chemotherapy or chemoradiation (CRT) is internationally accepted as the standard of care. Data from two large, randomized phase III trials support the use of perioperative
combination chemotherapy in lower oesophageal and oesophagogastric junction
adenocarcinomas, but the contribution of the adjuvant
therapy is uncertain. There are conflicting data from randomized studies of a purely neoadjuvant approach; however, recent meta-analyses have demonstrated that
chemotherapy or CRT given prior to radical surgery improves survival in patients with
adenocarcinoma of the oesophagus. Neoadjuvant CRT but not
chemotherapy alone is also beneficial for patients with
squamous cell carcinoma. Definitive CRT has emerged as a useful option for the treatment of resectable
squamous cell carcinoma of the oesophagus, avoiding potential surgical morbidity and mortality for most patients, with salvage surgery reserved for those with persistent disease. In this review, we focus on the
pharmacotherapy of resectable oesophageal and oesophagogastric junction
cancers and how clinical trials and meta-analyses inform current clinical practice.