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Is concurrent radiation therapy required in patients receiving preoperative chemotherapy for adenocarcinoma of the oesophagus? A randomised phase II trial.
- Source :
-
European journal of cancer (Oxford, England : 1990) [Eur J Cancer] 2011 Feb; Vol. 47 (3), pp. 354-60. - Publication Year :
- 2011
-
Abstract
- Introduction: Preoperative chemotherapy (CT) and preoperative chemoradiation therapy (CRT) for resectable oesophageal cancer have been shown to improve overall survival in meta-analyses. There are limited data comparing these preoperative therapies. We report the outcomes of a randomised phase II trial comparing preoperative CT and CRT for resectable adenocarcinoma of the oesophagus and gastro-oesophageal junction.<br />Methods: Patients were randomised to receive preoperative CT with cisplatin (80 mg/m(2)) and infusional 5 fluorouracil (1000 mg/m(2)/d) on days 1 and 21, or preoperative CRT with the same drugs accompanied by concurrent radiation therapy commencing on day 21 of chemotherapy and the 5 fluorouracil reduced to 800 mg/m(2)/d. The radiation dose was 35 Gy in 15 fractions over 3 weeks. The endpoints were toxicity, response rates, resection (R) status, progression-free survival (PFS), overall survival (OS) and quality of life.<br />Results: Seventy-five patients were enrolled on the study: 36 received preoperative CT and 39 preoperative CRT. Toxicity was similar for CT and CRT. Eight patients (11%) did not proceed to resection. The histopathological response rate (CRT 31% versus CT 8%, p = 0.01) and R1 resection rate (CRT 0% versus CT 11%, p = 0.04) favoured those receiving CRT. The median PFS was 14 and 26 months for CT and CRT respectively (p = 0.37). The median OS was 29 months for CT compared with 32 months for CRT (p = 0.83).<br />Conclusions: Despite no difference in survival, the improvement from preoperative CRT with respect to margin involvement makes this treatment a reasonable option for bulky, locally advanced resectable adenocarcinoma of the oesophagus.<br /> (Copyright © 2010. Published by Elsevier Ltd.)
- Subjects :
- Adenocarcinoma surgery
Adult
Aged
Cisplatin administration & dosage
Cisplatin adverse effects
Disease-Free Survival
Esophageal Neoplasms surgery
Female
Fluorouracil administration & dosage
Fluorouracil adverse effects
Humans
Male
Middle Aged
Neoadjuvant Therapy adverse effects
Neoadjuvant Therapy methods
Neoplasm Recurrence, Local etiology
Postoperative Complications etiology
Radiotherapy adverse effects
Treatment Outcome
Adenocarcinoma drug therapy
Adenocarcinoma radiotherapy
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Esophageal Neoplasms drug therapy
Esophageal Neoplasms radiotherapy
Subjects
Details
- Language :
- English
- ISSN :
- 1879-0852
- Volume :
- 47
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- European journal of cancer (Oxford, England : 1990)
- Publication Type :
- Academic Journal
- Accession number :
- 21084184
- Full Text :
- https://doi.org/10.1016/j.ejca.2010.09.009