Surgical Resection with or without pre-operative chemotherapy in oesophageal cancer: an updated analysis of a randomized controlled trial conducted by the UK Medical Research Council Upper GI Tract Cancer Group
Li Liu, MD
University of Pennsylvania Cancer
Last Modified: May 14, 2001
Presenter: P. Clark Affiliation: MRC Clinical Trials Unit, London, UK
The poor survival of patients with clinically localized squamous cell or adenocarcinoma of the esophagus suggests that occult dissemination of disease is present in most patients at diagnosis. This provides a rationale for adding a systemic therapy to local treatments.
Materials and Methods:
A total of 802 patients with resectable esophageal cancer of any cell type were included in this randomized study.
Patients were treatment with either two cycles of pre-operative chemotherapy with Cisplatin and 5-FU followed by resection (CS group) or resection alone (S group).
Cisplatin dose was 80mg/m2 on day 1, and 5-FU dose was 1000mg/m2 x 4 days.
Pre-operative radiation therapy (RT) was given to all patients at physician's discretion, consisted of 25 Gy/5 fractions.
Peri-operative death was 10% in both arms.
Post-operative complications were comparable between two groups.
Approximately 10% of patients received RT.
The median survival was 16.8 months in the CS group compared with 13.3 months in the S group.
2-year survival rates were 43% in the CS group compared with 34% months in the S group.
There were more complete resection performed in CS group.
When the patients who received RT were excluded from analysis, there was no survival difference between CS and S group.
Two cycles of pre-operative Cisplatin and 5-FU followed by resection appeared to be superior to resection alone in patients with respectable esophageal cancer.
Surgical complications were comparable between the two treatment groups.
Chemotherapy given before surgery may be of greater benefit in eradicating micrometastatic disease, preventing the emergence of drug- resistant clones, and, perhaps, facilitating resection.
Addition of pre-operative RT is of important value in selected patients and should be cooperated in randomized trials
The optimal treatment regimen and approach remains to be discovered.