The addition of radiotherapy to neoadjuvant chemotherapy improved histological complete response rate, R0 resection rate, and frequency of lymph node metastases, without significantly impacting survival.1
Although neoadjuvant therapy improves long-term survival after esophagectomy in patients with esophageal cancer or gastro-esophageal junction (GEJ) cancer, there is limited evidence on whether neoadjuvant chemotherapy or chemoradiotherapy is more beneficial. Therefore, researchers sought to compare the outcomes of chemotherapy with those of chemoradiotherapy in this patient population.
For the multicenter study, researchers enrolled 181 patients with carcinoma of the esophagus or GEJ who were eligible to undergo curative-intent treatment in Sweden and Norway. Participants were randomly assigned to receive chemotherapy with or without radiation, followed by surgery with 2-field lymphadenectomy.
Chemotherapy consisted of 3 cycles of platinum agent plus 5-fluorouracil and radiation was given concomitantly at a dose of 40 Gy in the chemoradiotherapy arm.
Results showed that 28% of patients achieved a histological complete response after chemoradiotherapy compared with 9% of those in the chemotherapy arm (P = .002). Lymph node metastases were observed in 62% and 35% of patients in the chemoradiotherapy and chemotherapy arm, respectively (P = .001).
Furthermore, researchers found that the R0 resection rate was 87% after chemoradiotherapy vs 74% after chemotherapy (P = .04). Of note, there was no difference in overall survival between the 2 treatment arms.
- Kievebro F, Alexandersson von Döbeln G, Wang N, et al. A randomised clinical trial of neoadjuvant chemotherapy vs. neoadjuvant chemoradiotherapy for cancer of the oesophagus or gastro-oesophageal junction [published online ahead of print January 17, 2016]. Ann Oncol. doi: 10.1093/annonc/mdw010.