Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: Systematic review with meta-analysis combining individual patient and aggregate data

Ronellenfitsch, Ulrich; Schwarzbach, Matthias; Hofheinz, Ralf; Kienle, Peter; Kieser, Meinhard; Slanger, Tracy; Burmeister, Bryan; Kelsen, David P.; Niedzwiecki, Donna; Schuhmacher, Christoph; Urba, Susan G.; Velde, Cornelis van de; Walsh, T. N.; Ychou, Marc; Jensen, Katrin

doi:10.1016/j.ejca.2013.05.029

Cited by 152 publications

(104 citation statements)

References 37 publications

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“…Nonetheless, this holds true only for EGJC but not for GC. Besides that, a meta-analysis by Ronellenfitsch found an effect of perioperative chemotherapy on OS only for EGJCbut not for GC-patients (14). Cunningham reported the same statement in the MAGIC-trial.…”

mentioning

confidence: 62%

Different regimens of perioperative chemotherapy for esophagogastric and gastric adenocarcinoma: does a triplet therapy with taxane generate a survival benefit?

Samm

Novotny

Friess

et al. 2017

Transl. Gastroenterol. Hepatol.

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With new diagnoses in more than 39,000 patients annually, esophagogastric cancer (EGC) is the seventh most common cancer worldwide and a serious health problem. It is a highly lethal disease, causing more than 25,000 deaths per year (1). Surgery with a radical lymphadenectomy is the mainstay of therapy for operable adenocarcinoma of the esophagogastric junction cancer (EGJC) and gastric cancer not involving the GEjunction cancer (GC) but many patients relapse and the 5-year survival rate remains low (2). Because of the poor prognosis of locally advanced disease, additional therapy besides oncologic surgery is required to improve patient outcome. Recent studies demonstrated that preoperative chemotherapy improves overall survival (OS) of patients with locally advanced EGJC/GC and histopathologic response was identified as an independent prognostic parameter in these patients (3,4). Several neoadjuvant chemotherapy regimens are under discussion and currently in use but the optimal treatment regimen remains unclear.The landmark MAGIC-trial recruited patients with resectable EJGC and GC. Here, 503 patients were randomized to either undergo surgery with perioperative chemotherapy or surgery only. The chemotherapy applied in this trial included three preoperative and three postoperative cycles of epirubicin, cisplatin and continuous 5-fluorouracil (5-FU) (ECF-regimen). There was at least no significant difference in postoperative complications and 30-day mortality in both treatment arms (46% vs. 45% and 5.6% vs. 5.9%, respectively). A clear downstaging effect could be monitored for patients in the chemotherapy arm. The resected tumors in that group were significantly smaller and less advanced. OS as well as progression-free survival (PFS) of patients receiving perioperative chemotherapy (CTx) were significantly increased compared with patients treated by surgery only (P=0.009 and P<0.001). Results showed that the 5-year survival rate (5YSR) was 36% for patients receiving perioperative CTx and 23% for patients treated by surgery only (P=0.009 and P<0.001) (5).The chemotherapeutic regimen of the French ACCORD-trial was composed of 2 or 3 cycles of cisplatin/5-FU and was disposed for patients with resectable EGJC/GC. The 224 patients were randomized to receive either preoperative chemotherapy or surgery only. The R0-resection rate among the patients receiving chemotherapy was significantly higher compared to the primary surgery arm (84% vs. 73%; P=0.04). A significantly prolonged overall and disease-free survival could be shown after chemotherapy (P=0.02 and P=0.003). The 5YSR largely matched those reported for the MAGIC-trial with 38% in the CTx + surgery and 24% in the surgery only arm (6).In contrast, the EORTC-trial by Schuhmacher showed a higher R0-resection rate among the patients treated with a neoadjuvant regimen consisting of cisplatin/5-FU/folinic Editorial

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mentioning

confidence: 62%

Different regimens of perioperative chemotherapy for esophagogastric and gastric adenocarcinoma: does a triplet therapy with taxane generate a survival benefit?

Samm

Novotny

Friess

et al. 2017

Transl. Gastroenterol. Hepatol.

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“…Moreover, GEJ lesions were in the past grouped with either esophageal or gastric tumors, thus a clear interpretation of the result from trials is difficult. A recent meta-analysis from Ronellenfitsch et al (80) found a significant benefit by the administration of preoperative CT (either associated with RT or not) for esophageal, gastric, and GEJ adenocarcinomas, globally analyzed, with an absolute OS increase of 9% at 5 years. Moreover, GEJ adenocarcinomas were the only subgroup maintaining significance in separated analysis, suggesting a potential specific role of trimodal approach in this subset.…”

Section: Trimodal Approachmentioning

confidence: 99%

Combined Modality Therapy for Thoracic and head and Neck Cancers: A Review of Updated Literature Based on a Consensus Meeting

Franco

Fiorentino

Dionisi³

et al. 2016

Tumori

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Purpose: Combined modality therapy is a mainstay option for thoracic malignancies and head and neck cancers. The integration of different strategies is based on the multidisciplinary approach of modern clinical oncology. Radiation oncologists have to be educated, trained, and updated to provide state-of-the-art care to cancer patients and thus educational meetings are crucial. Methods: The Italian Association of Radiation Oncology Young Members Working Group (AIRO Giovani) organized its 8 th national meeting, focused on combination therapy in lung, esophageal, and head and neck cancer (with a specific focus on larynx-preservation strategies for larynx/hypopharynx tumors), involving young professionals working in Italy. The meeting was addressed to young radiation oncologists, presenting state-of-the-art knowledge, based on the latest evidence in this field. We performed a review of the current literature based on the highlights of the Congress. Results: The multimodality approach of head and neck and thoracic malignancies includes surgery, chemotherapy, and radiotherapy, but also has to take into account new information and data coming from basic and translational research and including molecular biology, genetics, and immunology. All these aspects are crucial for the treatment of non-small-cell lung cancer and esophageal, esophagogastric junction, and larynx/hypopharynx malignancies. The integration of different treatments in the clinical decision-making process to combine therapies is crucial. Conclusions: Combination therapy has proved to be a consolidated approach in these specific oncologic settings, highlighting the importance of multimodality management in modern clinical oncology. Dedicated meetings on specific topics are helpful to improve knowledge and skills of young professionals in radiation oncology.

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“…In a meta-analysis by Ronellenfitsch et al [58] OS was 9% better after neoadjuvant therapy. This effect was seen 18 mo after surgery and lasted at least 10 years.…”

Section: Neoadjuvant Chemotherapymentioning

confidence: 99%

Multimodal treatment of gastric cancer in the west: Where are we going?

Marrelli

Połom

Manzoni

et al. 2015

WJG

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The incidence of gastric cancer (GC) is decreasing worldwide, especially for intestinal histotype of the distal third of the stomach. On the contrary, proximal location and diffuse Lauren histotype have been reported to be generally stable over time. In the west, no clear improvement in long-term results was observed in clinical and population-based studies. Results of treatment in these neoplasms are strictly dependent on tumor stage. Adequate surgery and extended lymphadenectomy are associated with good long-term outcome in early-stage cancer; however, results are still unsatisfactory for advanced stages (Ⅲ and Ⅳ), for which additional treatments could provide a survival benefit. This implies a tailored approach to GC. The aim of this review was to summarize the main multimodal treatment options in advanced resectable GC. Perioperative or postoperative treatments, including chemotherapy, chemoradiotherapy, targeted therapies, and hyperthermic intraperitoneal chemotherapy have been reviewed, and the main ongoing and completed trials have been analyzed. An original tailored multimodal approach to non-cardia GC has been also proposed.

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Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: Systematic review with meta-analysis combining individual patient and aggregate data

Cited by 152 publications

References 37 publications

Different regimens of perioperative chemotherapy for esophagogastric and gastric adenocarcinoma: does a triplet therapy with taxane generate a survival benefit?

Different regimens of perioperative chemotherapy for esophagogastric and gastric adenocarcinoma: does a triplet therapy with taxane generate a survival benefit?

Combined Modality Therapy for Thoracic and head and Neck Cancers: A Review of Updated Literature Based on a Consensus Meeting

Multimodal treatment of gastric cancer in the west: Where are we going?

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