Patient Summary: Superiority of trimodality therapy to surgery alone in esophageal cancer: Results of CALGB 9781
There is some controversy over the best treatment for surgically resectable esophageal cancer , so this study looked to compare surgery alone to chemotherapy followed by surgery (neoadjuvant chemotherapy). Eligible patients had stage I-III disease, with no or only local lymph node involvement. They were randomized to either surgery alone or cisplatin and 5-FU given concurrent with radiation therapy (RT), followed by the same surgery (esophagectomy with lymph node dissection).
The study was unfortunately closed in 2000 due to poor enrollment, but despite the small numbers, improved survival was seen in the multi-modality group. There was a statistically significant survival advantage of 4.5 years in the multimodality group vs. 1.8 years in the surgery alone group (p=0.02). This did come at a cost. As expected, side effects were greater, including low blood counts in 54% of patients and esophagitis in 40% of patients and 2 patients developed leaks at the surgical site (anastamosis) in the multimodality group. In the surgery only group, there were 2 post-operative deaths. The 5 year overall survival (with or without progression) was 39% in the multimodality group versus 19% in the surgery alone group. Progression free survival was also improved, with 9 relapses in the multimodality group versus 14 in the surgery group.
This study demonstrated long-term and progression free survival benefits for patients receiving trimodality treatment. Trimodality treatment represents the standard of care in patients with resectable esophageal adenocarcinoma.