Adjuvant chemoradiotherapy boosts esophageal cancer survival

By Lynda Williams

Chemoradiotherapy significantly improves the outcome of patients undergoing surgery for cancer of the esophagus or esophagogastric junction and is well tolerated, suggests research in TheNew England Journal of Medicine.

The phase III trial findings showed that patients with resectable tumors survived for a median of 49.4 months when given a neoadjuvant regimen an average of 6.6 weeks before surgery compared with 24.0 months for surgery alone (hazard ratio for death=0.66).

Patients who received chemoradiotherapy were also significantly more likely to achieve complete tumor resection within a 1 mm tumor margin than those who received surgery alone (92 vs 69%). Indeed, analysis of samples from 161 neoadjuvant-treated patients showed complete pathologic response in 29%.

Neoadjuvant treatment included 5 weeks of weekly carboplatin (dose titrated for area under the curve of 2 mg/mL per min) and paclitaxel (50 mg/m² body surface area) plus 41.4 Gy in 23 fractions given 5 days per week.

"The chemoradiotherapy was associated with a low frequency of high-grade toxic effects and could be given as an outpatient treatment," report Ate van der Grast (Erasmus University Medical Center, Rotterdam, the Netherlands) and co-authors.

In all, 7% of patients given neoadjuvant treatment experienced grade 3 hematologic toxicity and one patient developed grade 4 hematologic toxicity. Other major nonhematologic grade 3 or higher events occurred in 13% of patients, most commonly anorexia (5%) and leukopenia (6%).

The rate of postoperative complications was high, with around 45% of patients in both groups experiencing pulmonary complications. However, this did not significantly differ between the neoadjuvant treatment and surgery-alone groups, and the mortality rate was low, with 4% of each group dying in hospital.

The study included 366 patients with adenocarcinoma (75%), squamous cell carcinoma (23%), or large-cell undifferentiated carcinoma (2%) who were treated between March 2004 and December 2008. The majority of tumors were located at the distal esophagus (58%) or esophagogastric junction (24%), and positive lymph nodes were present in approximately 65% of patients.

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