TY - JOUR
T1 - Improved long-term outcome with chemoradiotherapy strategies in esophageal cancer
AU - Swisher, Stephen G.
AU - Hofstetter, Wayne
AU - Komaki, Ritsuko
AU - Correa, Arlene M.
AU - Erasmus, Jeremy
AU - Lee, Jeffrey H.
AU - Liao, Zhongxing
AU - Maru, Dipen
AU - Mehran, Reza
AU - Patel, Shital
AU - Rice, David C.
AU - Roth, Jack A.
AU - Vaporciyan, Ara A.
AU - Walsh, Garrett L.
AU - Ajani, Jaffer A.
N1 - Funding Information:
This work was supported by the Homer Flower Gene Therapy Research Fund , the Charles Rogers Gene Therapy Fund , the Charles B. Swank Memorial Fund for Esophageal Cancer Research , the George O. Sweeney Fund for Esophageal Cancer Research , the Phalan Thoracic Gene Therapy Fund , and the M. W. Elkins Endowed Fund for Thoracic Surgical Oncology .
PY - 2010/9
Y1 - 2010/9
N2 - Background: Controversy currently exists about the optimum preoperative treatment platform for locoregionally advanced esophageal cancer, namely, preoperative chemoradiotherapy (preoperative C/RT) or preoperative chemotherapy alone. We therefore reviewed sequential phase II/III trials performed at a single institution to assess the impact of preoperative chemotherapy versus preoperative C/RT strategies. Methods: In all, 157 esophageal cancer patients were sequentially enrolled in phase II/III trials at the University of Texas M.D. Anderson Cancer Center from March 27, 1990, to March 8, 2005. The treatment approaches included preoperative chemotherapy, n = 76 (INT 113 and ID90-01); preoperative C/RT, n = 81 (ID96-189 and DM98-349). Analysis was by intention to treat. Factors evaluated included demographics, preoperative staging, type of surgery, pathology, adjuvant therapies, and long-term outcome. Results: Adenocarcinoma predominated (85%), with cT3 (73%) and cN1 (43%). No significant difference was noted between groups in demographics or perioperative mortality. More patients with preoperative C/RT were staged with endoscopic ultrasound (52% versus 9%, p < 0.001). Preoperative C/RT demonstrated increased pathologic complete response (28% versus 4%, p < 0.001) and overall survival (3 years, 48% versus 29%, p = 0.04). Preoperative C/RT was a significant independent predictor of improved overall survival (hazard ratio 0.58, 95% confidence interval: 0.37 to 0.90, p = 0.015) and disease-free survival (hazard ratio 0.55, 95% confidence interval: 0.35 to 0.85, p = 0.007) in multivariable regression. Conclusions: In sequential phase II/III trials involving locoregionally advanced esophageal cancer patients, preoperative C/RT was associated with improved overall and disease-free survival rates (p = 0.046 and p = 0.015, respectively) and increased pathologic complete response (p < 0.001) compared with preoperative chemotherapy.
AB - Background: Controversy currently exists about the optimum preoperative treatment platform for locoregionally advanced esophageal cancer, namely, preoperative chemoradiotherapy (preoperative C/RT) or preoperative chemotherapy alone. We therefore reviewed sequential phase II/III trials performed at a single institution to assess the impact of preoperative chemotherapy versus preoperative C/RT strategies. Methods: In all, 157 esophageal cancer patients were sequentially enrolled in phase II/III trials at the University of Texas M.D. Anderson Cancer Center from March 27, 1990, to March 8, 2005. The treatment approaches included preoperative chemotherapy, n = 76 (INT 113 and ID90-01); preoperative C/RT, n = 81 (ID96-189 and DM98-349). Analysis was by intention to treat. Factors evaluated included demographics, preoperative staging, type of surgery, pathology, adjuvant therapies, and long-term outcome. Results: Adenocarcinoma predominated (85%), with cT3 (73%) and cN1 (43%). No significant difference was noted between groups in demographics or perioperative mortality. More patients with preoperative C/RT were staged with endoscopic ultrasound (52% versus 9%, p < 0.001). Preoperative C/RT demonstrated increased pathologic complete response (28% versus 4%, p < 0.001) and overall survival (3 years, 48% versus 29%, p = 0.04). Preoperative C/RT was a significant independent predictor of improved overall survival (hazard ratio 0.58, 95% confidence interval: 0.37 to 0.90, p = 0.015) and disease-free survival (hazard ratio 0.55, 95% confidence interval: 0.35 to 0.85, p = 0.007) in multivariable regression. Conclusions: In sequential phase II/III trials involving locoregionally advanced esophageal cancer patients, preoperative C/RT was associated with improved overall and disease-free survival rates (p = 0.046 and p = 0.015, respectively) and increased pathologic complete response (p < 0.001) compared with preoperative chemotherapy.
UR - http://www.scopus.com/inward/record.url?scp=77956148088&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77956148088&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2010.04.061
DO - 10.1016/j.athoracsur.2010.04.061
M3 - Article
C2 - 20732514
AN - SCOPUS:77956148088
SN - 0003-4975
VL - 90
SP - 892
EP - 899
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 3
ER -