Definitive or neo-adjuvant chemoradiation in esophageal carcinoma?

Management of resectable esophageal carcinoma is based on a multimodal treatment associating neo-adjuvant chemoradiation before surgery. This therapeutic sequence allows a disease-free survival rate at 2 years around 45% but remains associated with a high post-operative morbidity. In case of definitive chemoradiotherapy, the dose delivered to the macroscopic disease is a controversial topic since decades and the prognosis of patients treated in this setting at the dose of 50 Gy remains poor. This article proposes a review of the main published data and the ongoing studies related to the management of these patients.