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
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.
- 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.
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