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Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer
Journal of Clinical Oncology, 09/28/09

Allum WH et al. – Long-term follow-up confirms that preoperative chemotherapy improves survival in operable esophageal cancer and should be considered as a standard of care

Methods

Randomized, controlled trial (random assignment was to surgery alone (S) or to two cycles of combination cisplatin and fluorouracil before surgery (CS)
802 patients, 400 on CS and 402 on S
First recurrence event and cause of death are detailed
Survival determined from Kaplan-Meier curves and treatment comparisons made with the log-rank test
Survival by extent of resection is presented

Results

There were 655 deaths, 335 for S and 320 for CS
Survival benefit maintained with a HR of 0.84 (in absolute terms is a 5-year survival of 23.0% for CS compared with 17.1% for S)
Treatment effect consistent in both adenocarcinoma and squamous cell carcinoma
First disease-free survival event was macroscopic residual disease from incomplete resection (R2) or no resection in 26.4% of the S group versus 14.3% of the CS
3 year survival by type of resection was R0 42.4%, R1 was 18.0%, and R2 was 8.6%

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