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Eur J Cancer. 2014 Apr;50(6):1065-75. doi: 10.1016/j.ejca.2013.12.022. Epub 2014 Jan 27.

Chemoradiotherapy, with adjuvant surgery for local control, confers a durable survival advantage in adenocarcinoma and squamous cell carcinoma of the oesophagus.

Author information

1
Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Dublin 15, Ireland. Electronic address: garybassmd@gmail.com.
2
Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Dublin 15, Ireland.
3
Department of Surgery, St. James Hospital, Dublin, Ireland.

Abstract

INTRODUCTION:

Oesophageal cancer usually presents with systemic disease, necessitating systemic therapy. Neo-adjuvant chemoradiotherapy improves short-term survival, but its long-term impact is disputed because of limited accrual, treatment-protocol heterogeneity and a short follow-up of randomised trials.

AIMS:

Long-term results of two simultaneous randomised controlled trials (RCTs) comparing neo-adjuvant chemo-radiotherapy and surgery (MMT) with surgical monotherapy were examined, and the response of adenocarcinoma (AC) and squamous cell carcinoma (SCC) to identical regimens compared.

METHODS:

Between 1990 and 1997, two RCTs were undertaken on 211 patients. Patients with AC (n=113) or SCC (n=98) were separately-randomised to identical protocols of MMT or surgical monotherapy.

RESULTS:

211 patients were followed to 206 months; 104 patients were randomised to MMT (58 AC and 46 SCC, respectively) and 107 to surgery. MMT provided a significant survival-advantage over surgical monotherapy for AC (P=0.004), SCC (P=0.01). There was a 54% relative risk-reduction in lymph-node metastasis following MMT, compared with surgery (64% versus 29%, P<0.001). MMT produced a pathologic complete response (pCR) in 25% and 31% of AC and SCC, respectively. Survival advantage accrued to MMT, pCR and node-negative patients: AC pCR versus surgical monotherapy (P=0.001); residual disease following MMT versus surgical monotherapy (P=0.008); SCC pCR versus surgical monotherapy (P=0.033).

CONCLUSIONS:

A survival advantage for MMT persisted long-term in AC and was replicated in SCC. MMT produced loco-regional tumour down-staging to extinction in 25-31% of patients, potentially permitting personalised treatment in this cohort that avoids the morbidity and mortality associated with resection. Node-negative patients with residual localised disease following MMT had a survival advantage over node-negative patients following surgery alone, supporting a systemic effect on micro-metastatic disease.

KEYWORDS:

Long-term survival; Multi-modal therapy; Oesophageal cancer

PMID:
24480403
DOI:
10.1016/j.ejca.2013.12.022
[Indexed for MEDLINE]

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