Neoadjuvant radiotherapy is generally “concurrent radiotherapy”.
Synchronous radiotherapy means that chemotherapy is given at the same time as radiotherapy, primarily to enhance the tumor-killing effect of radiotherapy. The chemotherapy acts as a radiation “sensitizer”.
Protocols for neoadjuvant therapy
Neoadjuvant chemotherapy
Platinums in combination with paclitaxel or platinum in combination with fluorouracil are often chosen.
The physician will choose the appropriate chemotherapy regimen and dose based on each patient’s age, height, weight, blood work, liver and kidney function, tumor load size, and ECOG score. If the patient experiences intolerable adverse reactions after the drug is administered, he or she may choose to have the drug reduced or replaced with another chemotherapy drug.
It is important to note that there is no accepted first-line chemotherapy regimen for esophageal cancer in China. Each treatment center will choose the most appropriate chemotherapy regimen for the patient’s situation based on their own experience.
Neoadjuvant Radiotherapy
A regimen of about 5 weeks is usually used.
Because radiotherapy alone only controls the local tumor, it is not effective for potentially small distant metastases. So, either you do radiotherapy or just chemotherapy, and you don’t usually do preoperative radiotherapy alone.
Process of neoadjuvant therapy
Synchronous radiotherapy requires 5 days of treatment per week with 2 days off. Each course of radiation therapy takes only 8 to 10 minutes. So you don’t need to stay in the hospital for the entire 5 weeks or so of radiation therapy. However, you will need to keep in touch with your radiation therapist to tell him or her about any recent discomfort so that it can be managed promptly.
Synchronous chemotherapy is usually given on a weekly basis. During chemotherapy, there may be some acute reactions to the drug infusion that require prompt management by your doctor. Thus, throughout the course of synchronized chemotherapy, when chemotherapy is needed, you will usually need to be hospitalized, discharged when the chemotherapy is finished, and continue radiation therapy in the outpatient setting.
Co-written by Dr. Jing You Dr. Chang Liu
, Peking University Cancer Hospital