Chemoradiotherapy before surgery improves survival in esophageal carcinoma

Last Updated: 2001-07-30 15:59:27 EDT (Reuters Health)

WESTPORT, CT (Reuters Health) – In patients with esophageal carcinoma, treatment with 5-fluorouracil, cisplatin, and interferon alpha plus external-beam radiotherapy before esophagectomy can extend survival to 3 years or more in some cases, according to the results of a phase II trial.

Dr. Mitchell C. Posner, from the University of Chicago Hospitals, and colleagues studied 44 patients with nonmetastatic esophageal cancer who received chemoradiotherapy prior to resection. Seventeen of the 44 patients were still alive after a median followup period of 50 months, the researchers report in the July issue of the Archives of Surgery. Of these, 15 had no evidence of recurrent disease, and 14 survived for 3 years or more.

At the time this report was written (median followup 54 months), one of the long-term survivors had died of the cancer, one was living with recurrent disease and 12 were disease-free. Six patients had survived for more than 4 years and three for more than 5 years. Two patients had developed subsequent primary tumors.

"Clearly, the therapeutic benefit of induction chemoradiotherapy and esophagectomy remains to be assessed in larger multi-institutional phase III trials. At this time, however, surgery remains the standard treatment for locoregional confined disease in patients with esophageal cancer," Dr. Posner and colleagues conclude.

A large prospective trial of some 475 patients with esophageal cancer, sponsored by the Cancer and Leukemia Group B, is under way, Dr. Francis G. Duhaylongsod of Honolulu notes in an editorial. He comments that this trial, which is comparing chemoradiotherapy and surgery against surgery alone, "will have sufficient statistical power to detect a 20% difference in 5-year survival."

Arch Surg 2001;136:737-743.

-Westport Newsroom 203 319 2700

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