Chemoradiotherapy Improves Survival in Esophageal or Esophagogastric-Junction Cancer

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(ChemotherapyAdvisor) – Among patients with potentially curable esophageal or esophagogastric-junction cancer, neoadjuvant chemoradiotherapy improved overall survival and had acceptable rates of adverse events, according to a study in the May 31 issue of the New England Journal of Medicine.

The investigators randomly assigned 368 patients with resectable tumors to carboplatin AUC 2 and paclitaxel 50mg/m2 weekly for five weeks and concurrent radiotherapy 41.4Gy in 23 fractions, five days per week, followed by surgery (n=180), or to surgery alone (n=188) from March 2004 to December 2008.

Of the 366 patients included in the analysis, 275 (75%) had adenocarcinoma; 84 (23%), squamous cell carcinoma; and 7 (2%), large-cell undifferentiated carcinoma. In the chemoradiotherapy-surgery group, complete resection (R0) was achieved in 92% of patients vs. 69% in the surgery alone group (P<0.001). In 47 of 161 patients (29%) who underwent resection after chemoradiotherapy, pathological complete response was observed, the investigators reported.

Median overall survival (OS) was significantly better, 49.4 months, in the chemoradiotherapy-surgery group vs. 24.0 months in the surgery group (HR, 0.657; P=0.003).

Patients in the two groups had similar postoperative complications; in-hospital mortality was 4% in both. Leukopenia (6%) and neutropenia (2%) were the most common major hematologic toxic effects in the chemoradiotherapy-surgery group and anorexia (5%) and fatigue (3%) the most common nonhematologic toxic effects.


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