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Chemotherapy and Radiation Therapy Followed by Surgery Does Not Improve Survival in Patients with Stage I-II Squamous Cell Cancer of the Esophagus

The current treatment for patients with stage I and II cancer of the esophagus utilizes surgery alone. Patients with stage I cancer of the esophagus have cancer that invades beneath the surface lining but does not invade the muscular part of the esophagus and there is no lymph node or distant spread of cancer. Stage II cancer invades into or through the muscle of the esophagus but not into local structures (IIA). When there is regional lymph node involvement with any extent of primary cancer but no invasion of local structures this is called stage IIB. Because more than half of patients will have recurrence of cancer after surgery other treatments are being evaluated in an attempt to decrease the risk of cancer recurrence.

Combining chemotherapy and/or radiation therapy with surgery can increase a patient’s chance of cure and prolong survival in many cancers. Doctors in France performed a clinical trial in 297 patients with stage I-II squamous cancer of the esophagus to determine whether chemotherapy and radiation therapy administered before surgery could improve patient outcomes compared to treatment with surgery alone.

There were less recurrences of cancer in patients treated with radiation therapy and chemotherapy. However, this benefit was balanced out by an increase in deaths following surgery in patients who had received chemotherapy and radiation therapy. The average survival was 18.6 months for both groups. Survival at 3 years was approximately 35%. The presence of lymph node involvement (stage IIB) was associated with a bad outcome as was the inability to surgically remove all cancer.

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This study suggested that chemotherapy and radiation therapy was effective in decreasing local recurrences but that toxicities from the treatment were too high. They advised further studies in attempts to reduce toxicities. ( New England Journal of Medicine, Vol 337 No 3, pp 161-167, 1997)

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