Organ-Sparing Surgery Following Chemoradiation Is Effective in Nonmetastatic Esophageal Cancer

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(ChemotherapyAdvisor) – Selective organ-sparing surgery after chemoradiation therapy is an effective treatment for patients with nonmetastatic and resectable esophageal cancer, according to findings from the long-term, multicenter phase 2 Radiation Therapy Oncology Group 0246 trial presented during the 10th annual Gastrointestinal Cancers Symposium on January 25th in San Francisco, CA.

The findings “demonstrate the efficacy of a selective surgical resection approach following definitive chemoradiation in a predominantly adenocarcinoma population of locoregionally advanced esophageal cancer,” reported Stephen Swisher, MD, FACS, of the University of Texas M. D. Anderson Cancer Center in Houston, TX, and coauthors.

The study included 41 patients who were diagnosed with nonmetastatic, resectable esophageal cancer at 19 centers between 2003 and 2006. Patients were administered induction chemotherapy with 5-fluorouracil (5-FU; 650 mg/mg2/day IV), cisplatin (15 mg/mg2/day), and paclitaxel (200 mg/mg2/day) for two cycles, and then definitive concurrent chemoradiation (50.4 Gy at 1.8 Gy per fraction) involving daily 5-FU (300 mg/mg2/day) and cisplatin (15 mg/mg2/day) during the first 5 days, Dr. Swisher and coauthors reported.

“Following definitive chemoradiation, patients were evaluated for residual locoregional disease with chest and abdominal CT scans, EUS [endoscopic ultrasonography] and optional PET scans,” Dr. Swisher and coauthors reported. “If there was no suspected residual disease, patients were observed and monitored serially for recurrent disease at 3 months x 2, 6 months x 3, and then yearly.”

Patients with suspected recurrent or residual locoregional tumors but without systemic disease were considered for organ-preserving selective esophageal resection.

A total of 21 patients (51%) underwent resection after chemoradiation because of suspected residual or recurrent disease.

“With a median follow-up of 6.7 years (for 16 alive patients), the estimated overall 2.5- and 5-year survival rates are 46.3% (95% CI: 30.7%-60.6%) and 36.6% (22.3%-51.0%),” the authors reported.

Three patients (7.3%) died of treatment-associated toxicity. A total of 11 patients (27%) were alive and disease-free 70 to 90 months after chemoradiation; all but five patients (12%) had undergone surgical resection, Dr. Swisher reported.

The 2013 Gastrointestinal Cancers Symposium is co-sponsored by the American Gastroenterological Association (AGA) Institute, the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO), and the Society of Surgical Oncology (SSO).


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