Radiation and Chemo Before Esophageal Cancer Surgery Improves Survival
Adapted from the NCI Cancer Bulletin.
A significant survival benefit was evident for the preoperative (neoadjuvant) use of combination chemoradiotherapy and, to a lesser extent, for chemotherapy alone in patients with localized esophageal cancer in a meta-analysis of data from numerous clinical trials that was published in the March 2007 Lancet Oncology (see the journal abstract).
Traditional management of patients with localized esophageal cancer has been by surgical resection alone; however, "survival is poor...and many patients develop metastatic disease or locoregional recurrence soon after surgery," noted the researchers, led by Dr. Val Gebski of the National Health and Medical Research Council Clinical Trials Centre at the University of Sydney in Australia. Because of the high rate of surgical complications, "focus has turned to neoadjuvant treatment" as a way to improve survival, they added.
The meta-analysis included 10 randomized comparisons of neoadjuvant chemoradiotherapy versus surgery alone (1,209 patients) and eight studies of neoadjuvant chemotherapy versus surgery in 1,724 patients.
Results for chemoradiotherapy studies showed a 13-percent absolute improvement in survival at two years, with similar results for different tumor types: squamous cell carcinoma (SCC) and adenocarcinoma. Analysis of the neoadjuvant chemotherapy studies indicated a 2-year absolute survival benefit of 7 percent. Chemotherapy had no significant effect on all-cause mortality for patients with SCC, although there was a significant benefit for those with adenocarcinoma.
Most of the studies included in the meta-analysis were started before 1994. "[C]urrent trials have used higher doses of radiation (typically 50 Gy) that are likely to result in better downstaging of overt tumours as well as death of micrometastases," the researchers added.
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