In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 32, No. 3_suppl ( 2014-01-20), p. 81-81
Abstract:
81 Background: Esophageal 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 2 simultaneous RCTs comparing neo-adjuvant chemo-radiotherapy and surgery (MMT) with surgical monotherapy were examined, and the response of AC (AC) and SCC (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% vs 29%, P 〈 0·001). MMT produced a pCR in 25% and 31% of AC and SCC respectively. Survival advantage accrued to MMT, pCR and node-negative patients: AC pCR vs surgical monotherapy(P=0·001); residual disease following MMT vs surgical monotherapy(P=0·008);SCC pCR vs 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 tumor down-staging to extinction in 25-31% of patients, potentially permitting personalized treatment in this cohort that avoids the morbidity and mortality associated with resection. Node-negative patients with residual localized disease following MMT had a survival advantage over node-negative patients following surgery alone, supporting a systemic effect on micro-metastatic disease.
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/jco.2014.32.3_suppl.81
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2014
detail.hit.zdb_id:
2005181-5
