According to an article recently published in the journal Cancer, the addition of chemotherapy to neoadjuvant therapy improves outcomes, including survival, in patients with esophageal cancer.
The esophagus is a tube that connects the back of the throat to the stomach. Early esophageal cancer refers to cancer that has not spread from its site of origin. Locally advanced esophageal cancer refers to cancer that has spread from its site of origin but has not spread to distant sites in the body.
Standard treatment for locally advanced esophageal cancer includes surgery (if possible), chemotherapy, and radiation therapy. Neoadjuvant therapy (treatment prior to surgery), including chemotherapy and radiation therapy, is often used to reduce the size of the cancer prior to surgery; this allows for more complete surgical removal of the cancer. In addition, neoadjuvant therapy is thought to immediately kill cancer cells that may be in the body.
Researchers from the MD Anderson Cancer Center recently evaluated data regarding the addition of further chemotherapy to neoadjuvant chemotherapy plus radiation therapy for patients with locally advanced esophageal cancer.
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The researchers evaluated the outcomes of 130 patients with esophageal cancer who received neoadjuvant chemotherapy plus radiation therapy; their outcomes were compared to those of 117 patients who received the same treatment plus an additional course of chemotherapy (induction chemotherapy) prior to surgery.
- Anticancer responses occurred in 64% of patients treated with the additional induction chemotherapy, compared with 51% of patients treated with induction chemotherapy.
- Half of the patients treated with induction chemotherapy were alive without cancer at 43 months, compared with just 18 months for those who did not receive induction therapy.
- Cancer-free survival at three years was 54% for those treated with induction chemotherapy, compared with 36% for those not treated with induction chemotherapy.
- Cancer-free survival at five years was 35% for those treated with induction chemotherapy, compared with 30% for those not treated with induction chemotherapy.
- At three years overall survival was 59% for those treated with induction chemotherapy, compared with 41% for those not treated with induction chemotherapy.
- At five years overall survival was 43% for those treated with induction chemotherapy, compared to 28% for those not treated with induction chemotherapy.
- There were no differences between the two groups of patients in terms of complications following surgery.
The researchers concluded that induction chemotherapy in addition to neoadjuvant chemotherapy and radiation therapy improves survival among patients with locally advanced esophageal cancer.
Patients with locally advanced esophageal cancer may wish to speak with their physician regarding their individual risks and benefits of additional chemotherapy or the participation in a clinical trial evaluating novel therapeutic approaches. Sources of information regarding ongoing clinical trials include the National Cancer Institute (www.cancer.gov).
Reference: Malaisrie S, Hofstetter W, Correa A, et al. The Addition of Induction Chemotherapy to Preoperative, Concurrent Chemoradiotherapy Improves Tumor Response in Patients with Esophgeal Adenocarcinoma. Cancer. 2006; 107:967 – 974.