Who profits from neoadjuvant radiochemotherapy for locally advanced esophageal carcinoma?
| Autor: | Gustavo B. Baretton, Felix Rückert, J. Gastmeier, Stephan Kersting, Marius Distler, R. Konopke, Dag Dittert, Hans Detlev Saeger |
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| Rok vydání: | 2009 |
| Předmět: |
Male
Oncology medicine.medical_specialty Neoplasm Residual Time Factors Esophageal Neoplasms medicine.medical_treatment Kaplan-Meier Estimate Adenocarcinoma Disease-Free Survival Internal medicine Antineoplastic Combined Chemotherapy Protocols Carcinoma Humans Medicine Neoplasm Invasiveness Prospective Studies Prospective cohort study Neoadjuvant therapy Survival analysis Aged Neoplasm Staging Hepatology business.industry Patient Selection Gastroenterology medicine.disease Neoadjuvant Therapy Esophagectomy Treatment Outcome Chemotherapy Adjuvant Fluorouracil Lymphatic Metastasis Carcinoma Squamous Cell Lymph Node Excision Female Radiotherapy Adjuvant Cisplatin business Complication medicine.drug |
| Zdroj: | Journal of Gastroenterology and Hepatology. 24:886-895 |
| ISSN: | 1440-1746 0815-9319 |
| DOI: | 10.1111/j.1440-1746.2008.05732.x |
| Popis: | Background: Patients suffering from locally advanced esophageal carcinoma are generally treated using multimodal therapies. This prospective, non-randomized trial was performed to evaluate the survival benefit of neoadjuvant radiochemotherapy prior to surgery in comparison with surgery only. Patients & Methods: Histopathological outcomes and survival were compared between 61 patients who underwent neoadjuvant radiochemotherapy and 64 comparable control patients who had been under-staged. After neoadjuvant therapy, tumor regression was assessed using the method described by Mandard in 1994. Survival curves for the two groups were estimated using the Kaplan-Meier method, and compared with the log-rank test. Results: Median and 3-year recurrence-free survival for the entire group were 26 months and 39.7%, respectively. The median and 3-year overall survival reached 34 months and 48.1%. Patients who showed complete response to neoadjuvant therapy had significantly improved survival (35 months) compared to patients with residual tumor cells (28 months), patients with tumors unresponsive to radiochemotherapy (22 months), or patients who received surgery only (control group, 29 months). Patients with nodal-negative carcinomas showed significantly longer survival after surgery only and after neoadjuvant therapy compared to patients with lymph node-positive cancers. Conclusions: Complete response after neoadjuvant radiochemotherapy is associated with significantly improved survival. Negative nodal status is a major determinant of outcomes following primary operation or neoadjuvant treatment. |
| Databáze: | OpenAIRE |
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