A randomized clinical trial of neoadjuvant chemotherapy versus neoadjuvant chemoradiotherapy for cancer of the oesophagus or gastro-oesophageal junction

Klevebro, Fredrik; Döbeln, Gabriella Alexandersson von; Wang, N.; Johnsen, Gjermund; Jacobsen, Anne Birgitte; Friesland, Signe; Hatlevoll, Ingunn; Glenjen, Nils; Lind, Pehr; Tsai, Jon A.; Lundell, Lars; Nilsson, Magnus

doi:10.1093/annonc/mdw010

Cited by 313 publications

(305 citation statements)

References 19 publications

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“…Similar to previous reports, the most recent comparative study-the NeoRes randomized trial-showed a higher R0 resection rate after CRT compared to the chemotherapy group (87 vs 74%, p = 0.04) and a higher histologic complete response rate, which was 28% after CRT vs 9% after chemotherapy (p = 0.002), but it failed to demonstrate a difference in overall survival between the two treatment arms [28]. One hypothesis to explain the lack of a clear survival advantage when comparing the two approaches is that, despite providing better local control of the disease, neoadjuvant CRT is not the best approach in all patients; some of them, namely those who have microscopic systemic disease at diagnosis, may be better treated with exclusive chemotherapy.…”

Section: Neoadjuvant Therapy: Chemotherapy Versus Chemoradiotherapysupporting

confidence: 83%

“…Few studies have directly compared neoadjuvant chemotherapy to chemoradiotherapy [26][27][28]. Similar to previous reports, the most recent comparative study-the NeoRes randomized trial-showed a higher R0 resection rate after CRT compared to the chemotherapy group (87 vs 74%, p = 0.04) and a higher histologic complete response rate, which was 28% after CRT vs 9% after chemotherapy (p = 0.002), but it failed to demonstrate a difference in overall survival between the two treatment arms [28].…”

Section: Neoadjuvant Therapy: Chemotherapy Versus Chemoradiotherapymentioning

confidence: 99%

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Western strategy for EGJ carcinoma

et al. 2016

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In this paper, the epidemiological and clinicobiological behavior of esophagogastric junction (EGJ) adenocarcinoma in the West is compared and contrasted to that in the East, and an overview is provided of current therapeutic strategies employed for this type of tumor in Western countries. It is well known that multimodal treatment is the therapeutic standard in locally advanced EGJ adenocarcinoma, but whether neoadjuvant/perioperative chemotherapy (CT) or neoadjuvant chemoradiotherapy (CRT) is the optimal approach is still debated. Neoadjuvant CRT improves local control in locally advanced Siewert type I and II tumors, so it should be considered the treatment of choice. In the subset of these patients with microscopic systemic disease at diagnosis, more intensive exclusive chemotherapy protocols could be of benefit. Therefore, there is an urgent need to identify these patients before planning the treatment. For Siewert type III tumors, perioperative chemotherapy is the standard. While there is general agreement on the optimal surgical approach for Siewert types I and III (a two-field Ivor Lewis operation and a total gastrectomy with distal esophagectomy, respectively), no standard surgical treatment has been defined for Siewert type II tumors. When data from Western series on proximal and circumferential resection margins and on nodal spread in Siewert type II tumors are taken into account, the optimal surgical approach appears to be Ivor Lewis esophagectomy. Whether the extent of esophageal invasion can correctly predict nodal involvement in middle-upper mediastinal stations as a means to restrict indications for transthoracic esophagectomy requires further investigation in the West.

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Section: Neoadjuvant Therapy: Chemotherapy Versus Chemoradiotherapysupporting

confidence: 83%

Section: Neoadjuvant Therapy: Chemotherapy Versus Chemoradiotherapymentioning

confidence: 99%

Western strategy for EGJ carcinoma

et al. 2016

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“…Both treatment regimens have been shown to improve prognosis in comparison to surgery alone. However, no data exist favoring one approach over another [23]. Thus, there are multiple open questions regarding the optimal treatment for AEG II tumors with respect to perioperative treatment and surgical concepts.…”

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confidence: 99%

Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG II): thoracoabdominal or abdominal approach?

et al. 2017

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“…However, randomized trials did not result in consistent conclusions (2-7). Besides, studies reported that NCRT appeared to achieve better local control but did not significantly affect survival (12,13). It has been recognized that ESCC has different histological and clinical characteristics compared with esophageal adenocarcinoma carcinoma (EAC) (9,14,15).…”

Section: Discussionmentioning

confidence: 99%

Results of neoadjuvant therapy followed by esophagectomy for patients with locally advanced thoracic esophageal squamous cell carcinoma

Lin

et al. 2017

J. Thorac. Dis.

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Background: For patients diagnosed with locally advanced esophageal cancer, neoadjuvant therapy followed by surgery is the most common approach. However, randomized trials resulted in inconsistent conclusions. We conducted this retrospective study to evaluate the influence of neoadjuvant therapy on postoperative events and the influence on disease-free survival (DFS) and overall survival (OS). Methods:We retrospectively reviewed all of the patients underwent surgery following neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma (ESCC) during January 1st, 2013 and December 31st, 2015 in Fudan University Shanghai Cancer Center (FUSCC). Prognostic factors for DFS and OS were identified by univariate and multivariate analyses.Results: A total of fifty patients were included. Regarding postoperative morbidities, pneumonia and leakage occurred in 9 (18.0%) and 6 (12.0%) patients, respectively. For the whole patients, the 1-, 2-, 3-year DFS and OS rates were 57.0%, 48.0%, 42.0% and 86.0%, 73.0%, 62.0%, respectively. Lung metastasis and mediastinal node involvement were the most common relapse patterns. Univariate and multivariate analyses confirmed ypTNM stage as an independent prognostic factor for both DFS and OS; while leakage was an independent prognostic factor for DFS. Conclusions: Neoadjuvant therapy did not increase postoperative morbidities but did achieve favorable survival. The ypTNM stage was an independent prognostic factor for both DFS and OS. Long-term survival needs further investigation.

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A randomized clinical trial of neoadjuvant chemotherapy versus neoadjuvant chemoradiotherapy for cancer of the oesophagus or gastro-oesophageal junction

Abstract: NCT01362127 (https://clinicaltrials.gov; The full study protocol was registered in the Clinical Trials Database).

Cited by 313 publications

References 19 publications

Western strategy for EGJ carcinoma

Western strategy for EGJ carcinoma

Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG II): thoracoabdominal or abdominal approach?

Results of neoadjuvant therapy followed by esophagectomy for patients with locally advanced thoracic esophageal squamous cell carcinoma

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