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Neo-adjuvant therapy followed by surgery is the mainstay of curative treatment for locally advanced oesophageal cancer. Histological response in the neoadjuvant phase is often associated with better survival. The aim of this study was to compare responses in patients undergoing chemotherapy and surgery (CS) or chemoradiotherapy and surgery (CRS) and examine the impact of response on survival. Methods: Forty-seven patients underwent CS and 50 underwent CRS. Response to neo-adjuvant therapy was measured by tumour regression grade (TRG) where Grades 1-3 indicate complete or high degrees of response and Grades 4-5 indicate little or no response. Survival data was analysed using Kaplan-Meier and Cox regression analysis. Results: Although a significantly smaller proportion of patients had TRG 1-3 following CS compared to CRS (8/47 vs. 35/50, P = 0•001) those who responded did equally well in terms of medium-term survival (CS 81% and 52%, CRS 80% and 62•8% at 1 and 3 years). TRG 1-3 was associated with better survival than TRG 4-5 in both groups (overall TRG 1-3: 81% and 60%, TRG 4-5: 61% and 30% at 1 and 3 years, P = 0•02). Conclusions: Significant tumour regression occurs more frequently after chemoradiotherapy and surgery than chemotherapy and surgery. Tumour regression grade is a strong predictor of outcome after both forms of treatment.
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