ABSTRACT
It is the third most frequent cancer of the digestive system, its treatment for respectable stage [T3-T4a, No-N1] based on surgery. Preoperative radiochemotherapy remains a controversial strategy for both squamous cell carcinoma then for adenocarcinoma. Until recently, randomized studies combine the two histological types, often without any distinction. In randomized studied involving mainly or exclusively respectable localized squamous cell carcinoma, the preoperative radiochemotherapy increases the rate of complete resection, the pathological response, the rate of local control, and disease-free survival. The absence of any impact on overall survival may be linked to the toxic effects of this treatment. Meta-analyses have revealed a survival benefit of approximately 13% at 2 years. However, the methodology used was perhaps questionable. Two randomized trials [French and German] compared surgery or additional radiochemotherapy after a first phase of radiochemotherapy in locally advanced respectable squamous cell carcinomas [T3-T4, N0-N1]. Both drew the same that is surgery did not improve survival benefit for patients in complete response, which remains difficult to predict and highlight. Five randomized trials focusing on patients with adenocarcinoma of the esophagus or gastro esophageal junction, the results are contradictory with insufficient statistical power in some positive studies. The recently CROSS randomized trial in fact except to answer this question once and for all: preoperative radiochemotherapy has been beneficial in this Dutch trial in terms of rates of complete resection and overall survival, without postoperative mortality