Neoadjuvant chemotherapy in oesophageal cancer

Abstract

Neoadjuvant chemotherapy in oesophageal cancer has gained rapid favour in le United Kingdom over the past few years. It remains controversial outside the UK, with mixed results from clinical trials. The work in this thesis begins with a review of the literature on neoadjuvant chemotherapy, and of the antimetabolites and platinum agents used. The quantitative reverse transcriptase polymerase chain reaction (qRTPCR) used to identify molecular determinants of chemosensitivity is discussed followed by a look at the clinical experience of neoadjuvant chemotherapy at a single centre. Over the past six years 194 patients in Oxford have undergone neoadjuvant chemotherapy with cisplatin and 5-flurouracil. Six patients developed progressive disease, 12 patients stopped chemotherapy early, one patient died during chemotherapy and one patient had perforation of the oesophagus. Overall chemotherapy was well tolerated among patients with no significant increase in respiratory complications and anastomotic leak following the use of neoadjuvant chemotherapy. Following the advent of neoadjuvant chemotherapy, there has been a significant decrease in circumferential resection margin involvement, compared to historical controls. Locoregional recurrence and overall survival have also improved. Cox's multivariate analysis shows circumferential resection margin to be an independent prognostic factor for locoregional recurrence and overall survival.EThOS - Electronic Theses Online ServiceGBUnited Kingdo