A phase II randomized trial of induction chemotherapy versus no induction chemotherapy followed by preoperative chemoradiation in patients with esophageal cancer

Abstract

These data suggest that IC produces non-significant increase in the pathCR rate and does not prolong OS. Further development of IC before chemoradiation may not be beneficial. Clinical trial no.: NCT 00525915 (www.clinicaltrials.gov).

The Incremental Value of Subjective and Quantitative Assessment of 18F-FDG PET for the Prediction of Pathologic Complete Response to Preoperative Chemoradiotherapy in Esophageal Cancer

“…The finding that induction chemotherapy before chemoradiotherapy was associated with a significantly higher rate of pathCR in the current series was in line with a recent phase II randomized trial at MDACC that did report a difference in pathCR rate in favor of induction chemotherapy (26% vs. 13%), but this difference was not statistically significant in that trial (P 5 0.094) (42). The difference in significance and nonsignificance of the influence of induction chemotherapy on pathCR between the current study and the randomized trial cannot be fully explained.…”

Randomized Phase 2 Trial of S1 and Oxaliplatin-Based Chemoradiotherapy With or Without Induction Chemotherapy for Esophageal Cancer

“…A combination of induction chemotherapy and chemoradiotherapy before surgery may be an attractive approach to improving both systemic and local control rates. However, 2 prospective, randomized, phase 2 trials comparing 3-step and 2-step approaches failed to show additional benefit of induction chemotherapy in improving the pCR rate (5,6). However, most patients included in those analyses had adenocarcinoma.…”

“…The issue of combining these 2 preoperative modalities, which is theoretically attractive, has been raised by retrospective studies suggesting that induction chemotherapy may provide additional benefit when incorporated before preoperative chemoradiotherapy (3,4). However, 2 prospective, randomized trials involving mostly esophageal adenocarcinoma have failed to show benefit of this "3-step strategy" over the "2-step strategy" (5,6).…”

PET-guided treatment algorithms in oesophageal cancer: the promise of the near future!

“…In order to destroy these micrometastases, additional induction chemotherapy before trimodality therapy has been investigated all over the world. It is not completely clear whether the addition of induction therapy results in a survival benefit (2)(3)(4)(5). Nevertheless, two potential benefits have been reported: an increase of the nutritional status of patients due to less problems of dysphagia and an upfront identification of patients with a poor response for which neoadjuvant chemoradiotherapy might by unbeneficial and even harmful.…”