Induction Chemotherapy to Downstage Advanced Oesophageal Cancer Before Surgery

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After diagnosis of locoregionally advanced oesophageal tumors or disputable distant metastases, patients receive induction chemotherapy. The aim of chemotherapy in these patients is to downstage the tumor. After induction chemotherapy is complete and tumor size is reduced, oesophagectomy can be an option.

Researchers used an institution’s database to identify patients who received induction chemotherapy between January 2005 and December 2012. A multidisciplinary team created a treatment plan and the patient’s response to induction chemotherapy was assessed by CT. The Kaplan Meier method was used to calculate survival and the researchers performed univariable and multivariable analyses to find prognostic factors for survival.

The study included 124 patients with oesophageal tumors who were treated with induction chemotherapy. The patients were mainly treated for locoregionally advanced disease (80 patients). If the disease progressed after chemotherapy surgery was not an option (16 patients). Nineteen patients did not receive surgery because of persistent unresectability.

The median overall survival of these patients was 12 months. Eighty-nine patients were eligible for and underwent surgery and 13 were found to have unresectable tumors or distant metastases. Seventy-six patients were treated with oesophagectomy, 50 of those patients had tumor-free resection margins and were estimated to have a 5-year survival of 37%.

The researchers found, after univariable analysis, that a positive resection margin was associated with worse survival rates. Multivariable analysis, however, revealed that only pathological lymph node status with increasing hazard ratios was significant in relation to overall survival. 

Induction Chemotherapy to Downstage Advanced Oesophageal Cancer Before Surgery
After diagnosis of locoregionally advanced oesophageal tumors or disputable distant metastases, patients receive induction chemotherapy.
Researchers assessed induction chemotherapy followed by surgery for advanced esophageal cancer. They concluded that, in patients with advanced esophageal cancer, induction chemotherapy downstages tumors and facilitate a radical esophagectomy.
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