Chemotherapy/Radiation Prior to Surgery Improves Survival over Surgery Alone
According to results recently presented at the 2006 Gastrointestinal Cancers Symposium, treatment with chemotherapy and radiation therapy followed by surgery improves survival compared to surgery alone in the treatment of stages I-III 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. Stages I-III esophageal cancer refer to early through locally advanced stages of the disease.
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. Since results from previous trials have not been consistent in terms of survival with the use of neoadjuvant therapy for this disease, research continues to evaluate long-term survival with different treatment approaches.
Researchers associated with the Cancer and Leukemia Group B (CALGB) recently conducted a randomized trial to directly compare different treatment approaches in esophageal cancer. This trial included 56 patients; 30 were treated with neoadjuvant chemotherapy and radiation therapy followed by surgery, and 26 were treated with surgery alone.
Median follow-up was 6 years. Treatment with the addition of chemotherapy/radiation improved outcomes compared with surgery alone:
- Median survival was 4.5 years for patients treated with chemotherapy/radiation/surgery, compared with only 1.8 years for those treated with surgery alone.
- Survival at 5 years was 39% for those treated with chemotherapy/radiation/surgery, compared with only 16% for those treated with surgery alone.
- 14 patients treated with chemotherapy and radiation suffered surgical complications, compared with 17 patients treated with surgery alone.
- Hospital stays following surgery were approximately 11.5 days in the group treated with chemotherapy/radiation, compared with 10 days for those treated with surgery only.
The researchers concluded that neoadjuvant therapy with chemotherapy and radiation therapy prior to surgery appears to improve survival compared with surgery alone in the treatment of stages I-III esophageal cancer. However, since previous trials have produced conflicting results, patients with this disease should discuss individual risks and benefits of all treatment options with their physician.
Reference: Krasna M, Tepper J, Niedzwiecki D, et al. Trimodality therapy is superior to surgery alone in esophageal cancer: Results of CALGB 9781. Proceedings from the 2006 Gastrointestinal Cancers Symposium. Abstract #4.