A 55-year-old man presents with a 6-month history of progressive dysphagia, initially to solids and now to liquids, with a 10 kg weight loss. Upper GI endoscopy reveals an irregular ulcerative lesion in the mid-oesophagus. Biopsy confirms squamous cell carcinoma. CT staging shows no distant metastases and a tumour confined to the oesophageal wall without involvement of adjacent structures. Which of the following is the most appropriate primary treatment strategy?
- A Neoadjuvant chemoradiotherapy followed by oesophagectomy ✓
- B Palliative oesophageal stenting alone
- C Surgical resection without prior treatment
- D Definitive radiotherapy alone
Correct answer: A. Neoadjuvant chemoradiotherapy followed by oesophagectomy
Explanation
For resectable oesophageal squamous cell carcinoma, neoadjuvant chemoradiotherapy (e.g., CROSS protocol: carboplatin/paclitaxel + radiotherapy) followed by oesophagectomy is the standard of care, as it significantly improves R0 resection rates and overall survival compared to surgery alone. Palliative stenting is reserved for unresectable or metastatic disease. Surgery alone is inferior to multimodal therapy. Definitive chemoradiotherapy (not radiotherapy alone) may be used when surgery is not feasible.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.