Median overall survival is approximately twice as long for patients with esophageal or esophagogastric-junction cancer who undergo chemoradiotherapy before surgery than for those treated with surgery alone, investigators reported.
In an intent-to-treat analysis of 366 patients, the median overall survival was 49 months in the chemoradiotherapy plus surgery group, versus 24 months in the surgery group (hazard ratio, 0.657; P = .003). The findings were published May 31 in the New England Journal of Medicine.
The overall survival rates in the chemoradiotherapy plus surgery group were higher than those in the surgery-only group throughout the study: 82% vs. 70% (year 1), 67% vs. 50% (year 2), 58% vs. 44% (year 3), and 47% vs. 34% (year 5).
Significantly more patients in the chemoradiotherapy plus surgery group achieved complete resection (defined as no tumor within 1 mm of the resection margins) compared with the surgery-only group (92% vs. 69%, P less than .001), wrote Dr. Pieter van Hagen of Erasmus University Medical Center, Rotterdam, the Netherlands, and his colleagues.
Of 161 patients who underwent resection after chemoradiotherapy, 47 (29%) had a pathological complete response. Postoperative complications were similar between the two treatment groups, and in-hospital mortality was 4% in both groups (N. Engl. J. Med. 2012;366:2074-84).
Patients aged 18-75 years with tumors no larger than 8 cm in length and 5 cm in width were randomized to immediate surgery or surgery after a regimen of chemoradiotherapy. All patients met the World Health Organization (WHO) performance status score of 2 or lower, and had adequate pulmonary, hematologic, hepatic, and renal function.
Patients in the chemoradiotherapy group received an intravenous dose of carboplatin targeted at an area under the curve of 2 mg/mL per minute and paclitaxel at a dose of 50 mg per square meter of body surface area on days 1, 8, 15, 22, and 29. The patients were premedicated intravenously with dexamethasone, clemastine, ranitidine, and standard antiemetics.
For the radiation part of the treatment, they received a total radiation dose of 41.4 Gy delivered in 23 fractions of 1.8 Gy each. Five fractions were administered per week, starting on the first day of the first chemotherapy cycle. All patients were treated via external-beam radiation.
The study was supported by the Dutch Cancer Foundation. Dr. van Hagen had no relevant financial disclosures.