Can definitive chemoradiotherapy be an alternative to surgery for early-stage oesophageal cancer?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: Can definitive chemoradiotherapy (CRT) be an alternative to surgery for early-stage oesophageal cancer? A total of 622 papers were found using the reported search, of which 5 cohort studies represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Three cohort studies with very limited sample size reported that definitive CRT yielded comparable overall survival to surgery, whereas the other 2 studies with large sample size reported that definitive CRT yielded worse survival than surgery. Two of the cohort studies also reported that definitive CRT was associated with significantly higher rates of recurrence than surgery. The available evidence, while both scarce and of poor quality, suggests that definitive CRT for early-stage oesophageal cancer resulted in worse overall survival and more recurrence when compared to surgery. Therefore, we would recommend that surgery still remains the standard treatment for patients with early-stage oesophageal cancer, whereas definitive CRT could be an alternative to surgery for patients unfit for surgery, although with slightly inferior outcomes.