[Medical Q&A] If the tumor "disappeared" after esophageal cancer chemotherapy and radiotherapy, is surgery still necessary?

Author: Chen Keneng, Chief Physician, Peking University Cancer Hospital

Reviewer: Yao Shukun, Chief Physician, China-Japan Friendship Hospital

Theoretically, it is possible that after esophageal cancer has undergone radiotherapy and chemotherapy, the tumor "disappears" and no surgery is needed. However, there is a major flaw: it is impossible to determine whether the tumor is really gone!

The esophagus is a hollow organ, and the judgment of hollow organs is very inaccurate. For example, lung cancer is very clear, lymph nodes can be seen very clearly, and it is easy to take a biopsy. But esophageal cancer is different. Examinations such as ultrasound gastroscopy, CT, magnetic resonance imaging, PET/CT, etc. have only a certain sensitivity and accuracy, and are not 100% accurate. Therefore, even if neoadjuvant chemoradiotherapy is performed before surgery, the patient feels that his symptoms are completely relieved, and the examination also finds that the tumor has disappeared, but in fact the possibility that the tumor still exists is very high, but we have not found it through the existing technical means.

Therefore, surgery is still recommended for esophageal cancer after neoadjuvant chemoradiotherapy. It is recommended that patients with esophageal cancer wait at least 6 to 8 weeks after neoadjuvant chemoradiotherapy before undergoing surgery. Because after 3 cycles of chemotherapy, the adverse reactions will be alleviated or basically disappear; the time after radiotherapy is a little longer, so after chemotherapy and radiotherapy, surgery should be performed 6 to 8 weeks later. At this time, the tumor has shrunk but has not grown back. At the same time, the patient's symptoms have been relieved, adverse reactions have disappeared, the patient's tolerance is better, and the physical strength and cardiopulmonary function are also better, so it is more appropriate to perform surgery at this time. Of course, each patient's situation is different, and a comprehensive evaluation is needed to make a comprehensive judgment.