Preoperative chemoradiotherapy doubled median overall survival among patients with esophageal or esophagogastric junction cancer compared to surgery alone, according to the results of a phase 3 study published in the New England Journal of Medicine.
The esophagus is a muscular tube that food and liquids pass through on their on their way to the stomach. Each year in the United States, more than 17,000 people are diagnosed with cancer of the esophagus and more than 15,000 die of the disease. For patients with esophageal cancers that can be surgically removed, surgery plays in an important role in treatment; however, it is less clear whether chemotherapy and radiation therapy prior to surgery improves outcomes.
To explore the efficacy of neoadjuvant (before surgery) chemoradiotherapy, researchers in the Netherlands conducted a Phase III clinical trial that included 366 patients with operable tumors. Patients were assigned to treatment with surgery alone or with chemotherapy and radiation therapy followed by surgery. Chemotherapy—which was administered concurrently with radiation therapy—consisted of paclitaxel and carboplatin.
The results indicated that preoperative chemoradiotherapy reduced the risk of death by 34 percent. Median overall survival was significantly longer in the group that received chemoradiotherapy—49.4 months, compared to 24 months in the group that received surgery alone. What’s more—complete resection with no tumor within 1 mm of the resection margins was achieved in 92 percent of patients in the chemoradiotherapy–surgery group versus 69 percent in the surgery group.
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The most common major hematological side effects among patients in the chemoradiotherapy group were leukopenia and neutropenia. The most common non-hematologic side effects were anorexia and fatigue.
The researchers concluded that preoperative chemoradiotherapy is safe and improved survival among patients with potentially curable esophageal or esophagogastric-junction cancer.
van Hagen P, Hulshof JJB, van Lanschot EW, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. New England Journal of Medicine. 2012; 366: 2074-2084.