Esophageal cancer treatment can include chemotherapy, surgery and radiotherapy. Chemotherapy, if it happens before surgery is called neoadjuvant chemotherapy. Treatment after the surgery is adjuvant chemotherapy. Dr. Anton Titov, MD. How to decide which patients may benefit from neoadjuvant chemotherapy before the surgical operations and which patients should proceed straight to surgery? Well, at initial staging, we will estimate whether esophageal cancer is locally advanced. Dr. Jari Rasanen, MD. And that means that whether it is any sign of lymph node metastases in the initial staging. Then we recommend the patient to have neoadjuvant treatment before surgery because there is a lot of evidence that the neoadjuvant treatment is more efficient than adjuvant chemotherapy for the patient with esophageal carcinoma. One of the reasons is that usually the patient can tolerate a lot better neoadjuvant chemotherapy than adjuvant chemotherapy after surgery because it takes time to recover from surgery. Therefore, there are many patients who cannot even get the adjuvant chemotherapy. So basically, it's now a lot more common to recommend the patient to have the chemotherapy before the surgery and not after the surgery for esophageal carcinoma. Patients may have neoadjuvant chemotherapy before surgical operation. Do these patients benefit from adjuvant chemotherapy after the surgery for esophageal carcinoma? it's a little bit controversial. There are studies which that prove that the patient will get the benefit. On the other hand, some studies are against that. It's obvious that you need to decide on an individual basis that there is no definitive right or wrong answer to that question.