Surgical Resection with or without pre-operative chemotherapy in oesophageal cancer: an updated analysis of a randomized controlled trial conducted by the UK Medical Research Council Upper GI Tract Cancer Group

Li Liu, MD

University of Pennsylvania Cancer
Ultima Vez Modificado: 14 de mayo del 2001

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Presenter: P. Clark
Affiliation: MRC Clinical Trials Unit, London, UK

Background:

    The poor survival of patients with clinically localized squamous cell or adenocarcinoma of the esophagus suggests that occult dissemination of disease is present in most patients at diagnosis. This provides a rationale for adding a systemic therapy to local treatments.

Materials and Methods:

  • A total of 802 patients with resectable esophageal cancer of any cell type were included in this randomized study.
  • Patients were treatment with either two cycles of pre-operative chemotherapy with Cisplatin and 5-FU followed by resection (CS group) or resection alone (S group).
  • Cisplatin dose was 80mg/m2 on day 1, and 5-FU dose was 1000mg/m2 x 4 days.
  • Pre-operative radiation therapy (RT) was given to all patients at physician's discretion, consisted of 25 Gy/5 fractions.

Results:

  • Peri-operative death was 10% in both arms.
  • Post-operative complications were comparable between two groups.
  • Approximately 10% of patients received RT.
  • The median survival was 16.8 months in the CS group compared with 13.3 months in the S group.
  • 2-year survival rates were 43% in the CS group compared with 34% months in the S group.
  • There were more complete resection performed in CS group.
  • When the patients who received RT were excluded from analysis, there was no survival difference between CS and S group.

Authors' Conclusions

  • Two cycles of pre-operative Cisplatin and 5-FU followed by resection appeared to be superior to resection alone in patients with respectable esophageal cancer.
  • Surgical complications were comparable between the two treatment groups.

Clinical/Scientific Implications:

  • Chemotherapy given before surgery may be of greater benefit in eradicating micrometastatic disease, preventing the emergence of drug- resistant clones, and, perhaps, facilitating resection.
  • Addition of pre-operative RT is of important value in selected patients and should be cooperated in randomized trials
  • The optimal treatment regimen and approach remains to be discovered.

ASCO Abstract 502

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OncoLink ASCO 2001 coverage is provided by an unrestricted educational grant from Amgen

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