Neoadjuvant CRT Improves Survival in Locally Advanced Squamous Cell Esophageal Cancer

Adding chemoradiotherapy prior to surgery improves survival versus surgery alone in patients with locally advanced esophageal squamous cell carcinoma (SCC), according to a study presented at the European Society for Medical Oncology (ESMO) 2016 Congress.¹

Although neoadjuvant chemoradiotherapy appears to improve survival for patients with locally advanced esophageal SCC, findings from previous reports are inconsistent. Researchers therefore evaluated the impact of chemoradiotherapy administration prior to surgery in this patient population.

For the multicenter, phase 3 trial (ClinicalTrials.gov Identifier: NCT01216527), researchers enrolled 451 patients with stage IIB or III squamous cell esophageal carcinoma. Participants were randomly assigned 1:1 to receive either preoperative radiotherapy with cisplatin plus vinorelbine followed by surgery 4 to 8 weeks after chemoradiotherapy, or to surgery alone. Patients also underwent 2-field lymphadenectomy with total mediastinal lymph node dissection during surgery.

Median follow-up was 30.6 months; the 3-year overall survival rate was 69.6% in the chemoradiotherapy arm compared with 62.4% in the surgery alone arm, corresponding to a 29% reduced risk of death with multidisciplinary therapy.

Researchers also found that there was a significant difference in the rate of R0 resection between arms (98.4% with chemoradiotherapy versus 91.2% with surgery alone).

In addition, 43.2% of those who underwent resection in chemoradiotherapy group achieved a pathological complete response.                       

Reference

1. Yang H, Fu J, Liu M, et al. A phase III clinical trial of neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of the esophagus. Paper presented at: European Society for Medical Oncology (ESMO) 2016 Congress; October 7-11, 2016; Copenhagen, Denmark.