key: cord-0784465-mqc4j6c8
authors: Tchelebi, Leila T.; Goodman, Karyn
title: Response to, “Role of neoadjuvant radiochemotherapy for esophageal cancers over pre/peri-operative chemotherapy in the era of COVID-19 and beyond”
date: 2020-07-13
journal: Radiother Oncol
DOI: 10.1016/j.radonc.2020.07.011
sha: bcffd33e2dc60cc317c22832a8a1a0823d78aefe
doc_id: 784465
cord_uid: mqc4j6c8

nan

We appreciate the opportunity to review the response of Dr. Cellini and colleagues to our manuscript "Recommendations on the use of radiation therapy in managing patients with gastrointestinal malignancies in the era of COVID-19." 1 We agree with Dr. Cellini that preoperative chemoradiation, and not preoperative chemotherapy, is and should remain the standard of care in the management of esophageal cancer, of either histology. As Dr. Cellini and colleagues point out, while there are no randomized studies directly comparing preoperative chemotherapy to preoperative chemoradiation, the results of two meta-analyses indicate the superiority of the combined modality approach 2; 3 and this is reflected in national guidelines. 4 First, we should clarify that we did not suggest replacing preoperative chemoradiation with preoperative chemotherapy, rather, we suggested the possibility of induction chemotherapy preceding preoperative chemoradiation. Second, it should be noted that we acknowledge that this was a controversial recommendation based on limited, but highly promising, data. [5] [6] [7] Some cancer centers hit particularly hard by the COVID-19 pandemic have tried to minimize inperson clinic visits for patients to reduce exposure to the virus, thus leading many radiation oncology departments to delay daily radiation therapy for as long as it is safe to do so. Under these dire circumstances, we feel that the available data is sufficient to support delaying preoperative chemoradiation through the use of induction chemotherapy for patients with esophageal adenocarcinoma. Moreover, this approach has been shown to be safe and effective in patients with adenocarcinoma of the gastroesophageal junction. 8 In sum, we agree that neoadjuvant chemoradiation should remain the standard of care in the management of resectable esophageal cancer until more data becomes available to support induction chemotherapy followed by chemoradiation. For centers strained for resources in the COVID-19 era, induction chemotherapy as a means of delaying daily radiation therapy until after the peak of the pandemic is a reasonable approach.

Recommendations for the use of radiation therapy in managing patients with gastrointestinal malignancies in the era of COVID-19

Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: systematic review with meta-analysis combining individual patient and aggregate data

Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis

The Updated Results for the Phase 3 Study of 5×5 Gy Followed By Chemotherapy in Locally Advanced Rectal Cancer (STELLAR trial)

Survival outcomes from CALGB 80803 (Alliance): A randomized phase II trial of PET scandirected combined modality therapy for esophageal cancer

Preoperative therapy with concurrent paclitaxel/carboplatin/infusional 5-FU and radiation therapy in locoregional esophageal cancer: final results of a Minnie Pearl Cancer Research Network phase II trial

Multi-center phase II trial of chemo-radiotherapy with 5-fluorouracil, leucovorin and oxaliplatin in locally advanced esophageal cancer

Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction