Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus
| Autor: | Jean-François Bosset, Marc Gignoux, Jean-Pierre Triboulet, Emmanuel Tiret, Georges Mantion, Dominique Elias, Patrick Lozach, Jean-Claude Ollier, Jean-Jacques Pavy, Mariette Mercier, Tarek Sahmoud, Philippe Ségol, Jean-Bernard Flamant, Jean-Pierre Arnaud, Jean-Pierre Plachot, Anne-Marie Mandard, Gaelle Chaillard |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Male
medicine.medical_specialty Randomization Esophageal Neoplasms medicine.medical_treatment Antineoplastic Agents Disease-Free Survival medicine Combined Modality Therapy Humans Neoplasms Squamous Cell Esophagus Neoplasm Staging Esophageal disease business.industry General Medicine Middle Aged medicine.disease Prognosis Survival Analysis Surgery Radiation therapy medicine.anatomical_structure Epidermoid carcinoma Esophagectomy Female Cisplatin Neoplasm Recurrence Local business Chemoradiotherapy |
| Zdroj: | The New England journal of medicine. 337(3) |
| ISSN: | 0028-4793 |
| Popis: | We conducted a multicenter, randomized trial to compare preoperative chemoradiotherapy followed by surgery with surgery alone in patients with stage I and II squamous-cell cancer of the esophagus.The preoperative combined therapy consisted of two one-week courses; each involved radiotherapy, in a dose of 18.5 Gy delivered in five fractions of 3.7 Gy each, and 80 mg of cisplatin per square meter of body-surface area, administered 0 to 2 days before the first day of radiotherapy. The surgical plan included one-stage en bloc esophagectomy and proximal gastrectomy by the abdominal and right thoracic routes, to be performed immediately after randomization in the group assigned to surgery alone and two to four weeks after the completion of preoperative chemoradiotherapy in the group assigned to combined therapy.A total of 297 patients entered the study; 11 were found to be ineligible, and 4 were lost to follow-up. Of the remaining 282, 139 were assigned to surgery alone and 143 to combined therapy. After a median follow-up of 55.2 months, no significant difference in overall survival was observed; the median survival was 18.6 months for both groups. As compared with the group treated with surgery alone, the group treated preoperatively had longer disease-free survival (P=0.003), a longer interval free of local disease (P=0.01), a lower rate of cancer-related deaths (P=0.002), and a higher frequency of curative resection (P=0.017). However, there were more postoperative deaths (P=0.012) in the group treated preoperatively with chemoradiotherapy. Three prognostic factors were found to influence survival in a multivariate analysis: the disease stage, based on computed tomography; the location of the tumor; and whether the surgical resection was curative.In patients with squamous-cell esophageal cancer, preoperative chemoradiotherapy did not improve overall survival, but it did prolong disease-free survival and survival free of local disease. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|