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©The Author(s) 2016.
World J Gastroenterol. Oct 21, 2016; 22(39): 8750-8759
Published online Oct 21, 2016. doi: 10.3748/wjg.v22.i39.8750
Published online Oct 21, 2016. doi: 10.3748/wjg.v22.i39.8750
Table 3 Salient features of randomized controlled trials addressing the role of preoperative chemoradiotherapy followed by surgery vs surgery alone in the management of esophageal cancer
Trial | Study period | Treatment | No. of patients | Histology | Completed treatment | R0 | pCR | pN+ | LRR | Median survival (mo) | OS | Treatment related mortality | DFS median/proportions | Conclusion |
Apinop et al[31], 1994 | 1986-1992 | FC + 40 Gy RT + Surgery | 35 | SCC | 26 | NA | 26.9% | NA | NA | NA | NS | NS | NA | No statistically significant difference in OS, complication rate, mortality |
Surgery | 34 | SCC | - | NA | - | NA | NA | NA | NS | NS | NA | |||
Le Prise et al[32], 1994 | 1988-1991 | Sequential FC-20 Gy RT-FC + Surgery | 41 | SCC | 39 | 51.0% | NA | 17.9% | 10 | 19.2 (3 yr) | 8.5% | 7.6 mo | No change in operative mortality or survival time | |
Surgery | 45 | SCC | 42 | 36.0% | - | NA | 21.4% | 10 | 13.8 (3 yr) | 7% | 5 mo | |||
Walsh et al[33], 1996 | 1990-1995 | FC + 40 Gy RT + Surgery | 58 | AC | 53 | NA | 25% | 42 | NA | 32 | 37 (3 yr) | 3% | NA | Multimodal treatment superior to surgery alone |
Surgery | 55 | AC | 54 | NA | - | 82 | NA | 11 | 07 (3 yr) | 2% | NA | |||
Lee et al[34], 2004 | 1999-2002 | FC + 45.6 Gy RT + Surgery | 51 | SCC | 35 | 100% | 43% | 37 | 22.8% | 28.2 | 55 (2 yr) | 8.5% | 49% (2 yr) | CRT induced high clinical and pathological response, but no statistically significant benefit in OS and DFS |
Surgery | 50 | SCC | 48 | 87.5% | - | 78 | 10.8% | 27.3 | 57 (2 yr) | 51%(2 yr) | ||||
Burmeister et al[35], 2005 | 1994-2000 | FC + 35 Gy RT + Surgery | 128 | 45 SCC + 80 AC + 3 others | 105 | 80.0% | 16% | 43 | 11% | 22.2 | NS | 4.7% | 16 mo | No significant improvement in PFS or OS |
Surgery | 128 | 50 SCC+ 78 AC | 110 | 59.0% | - | 67 | 14% | 19.3 | NS | 5.4% | 12 mo | |||
Tepper et al[36], 2008 (CALGB 9781) | 1997-2000 | FC+ 50.4 Gy RT + Surgery | 30 | 7 SCC + 23 AC | 29 | 84.6% | 40% | 12 | 13.7% | 53.7 | 39 (5 yr) | 5 yr | 28% (5 yr) | Long-term survival advantage supports trimodality therapy as a standard of care |
Surgery | 26 | 7 SCC+ 19 AC | 26 | 88.4% | - | NA | 15.3% | 21.4 | 16 (5 yr) | 3.8% | 15% (5 yr) | |||
Lv et al[37], 2010 | 1997-2004 | 2 Cis, Pacli+ 40 gy + Surgery | 80 | SCC | 80 | 97.4% | NA | NA | 11.3% | 53 | 24.5 (10 yr) | 3.4% | 61.3% (3 yr) | Rational application of pre-op or post-op CRT can improve PFS, OS |
Surgery | 80 | SCC | 80 | 80.0% | - | NA | 35% | 36 | 12.5 (10 yr) | 0% | 49.3% (3 yr) | |||
Van Hagen et al[38], 2012 (CROSS trials) | 2004-2008 | 5 Pacli, Carbo + 41.4 Gy + Surgery | 178 | 41 SCC + 134 AC + 3 other | 168 | 92.0% | 29% | 13 | 3.3% | 49.4 | 47 (5 yr) | 5.9% | not reached | Improved survival with acceptable adverse-event rates |
Surgery | 188 | 43 SCC + 141 AC + 4 other | 186 | 69.0% | - | 75 | 9.3% | 24 | 34 | 6.9% | 24.2 mo | |||
Mariette et al[39], 2014 | 2000-2009 | 2 Cis, 5FU + Surgery | 98 | 67 SCC + 30 AC+ 1 other | 84 | 93.8% | 33.3% | 30.8 | 22.1% | 31.8 | 41 (5 yr) | 11.1% | 35.6% (5 yr) | No effect on R0 resection rate or survival but enhanced postoperative mortality |
Surgery | 97 | 70 SCC + 27 AC | 91 | 92.1% | - | 52.8 | 28.9% | 41.2 | 33.8 | 3.4% | 27.7% (5 yr) |
- Citation: Garg PK, Sharma J, Jakhetiya A, Goel A, Gaur MK. Preoperative therapy in locally advanced esophageal cancer. World J Gastroenterol 2016; 22(39): 8750-8759
- URL: https://www.wjgnet.com/1007-9327/full/v22/i39/8750.htm
- DOI: https://dx.doi.org/10.3748/wjg.v22.i39.8750