According to the results of a phase III clinical trial published in the journal Lancet Oncology, treating localized esophageal cancer with chemotherapy and radiation therapy before surgery does not improve survival compared to treatment with surgery alone. An exception to this may include patients diagnosed with a type of esophageal cancer referred to as squamous cell cancer.
The esophagus is a multi-layered, hollow tube that connects the throat and stomach, allowing transportation of food and fluids. The prognosis for esophageal cancer depends on three factors: the stage (extent of spread) at which disease is diagnosed, the size of the tumor, and the patient’s general health. Current treatments include surgery, radiation, chemotherapy, or a combination of these options. For patients with localized esophageal cancer (cancer confined to the esophagus and nearby lymph nodes), researchers have hypothesized that treatment with chemotherapy and radiation therapy before surgery will shrink the cancer and improve the likelihood that surgery will remove the cancer, as well as immediately kill any undetectable cancer that may have spread in the body.
In order to compare treatment of localized esophageal cancer with chemotherapy and radiation therapy followed by surgery to treatment with surgery alone, researchers in Australia and New Zealand conducted a phase III clinical trial among 256 esophageal cancer patients. Half of the patients had surgery after pre-treatment with the chemotherapy drugs cisplatin and fluorouracil and radiation therapy, and half were treated with surgery alone.
As hypothesized, doctors were more able to remove the cancer in the patients pre-treated with chemotherapy and radiation before surgery. Unfortunately, despite more complete removal of the cancer, patients pre-treated with chemotherapy and radiation did not survive longer and had similar rates of cancer progression as the patients treated with surgery alone. The researchers further assessed whether patients with different types of esophageal cancer had different outcomes; they found that pretreatment with chemotherapy and radiation therapy may benefit some patients with squamous cell cancers, but did not appear to improve survival among patients with non-squamous cell cancers.
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The researchers conclude that for localized esophageal cancer, pre-treatment with chemotherapy and radiation therapy prior to surgery offers no survival advantage compared to treatment with surgery alone. They note, however, that additional studies should be conducted among patients with squamous cell esophageal cancers in order to better understand whether pretreatment with chemotherapy and radiation therapy benefits this subgroup of patients. Patients with localized esophageal cancer may wish to speak with their physician regarding their individual risks and benefits of participation in a clinical trial further evaluating promising therapeutic approaches. Sources of information regarding ongoing clinical trials include the National Cancer Institute (www.cancer.gov).
Reference: Burmeister BH, Smithers BM, Gebski V et al. Surgery alone versus chemoradiotherapy followed by surgery for respectable cancer of the esophagus: a randomized controlled phase III trial. Lancet Oncology. Early online publication August 11, 2005.