Complete 5-year follow-up of a prospective phase II trial of preoperative chemoradiotherapy for esophageal cancer

Mitchell C. Posner, William E. Gooding, John Lew, Maury M. Rosenstein, Barry C. Lembersky

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background. Conclusive evidence supporting the routine use of multimodality therapy in esophageal cancer is lacking. However, since long-term survival after esophagectomy alone is unusual, clinical trials designed to identify effective therapeutic regimens are essential. We report here the 5-year results of a phase Ii induction chemoradiotherapy trial. Methods. From August 1991 to January 1995, 44 patients with esophageal or gastroesophageal junction carcinoma were treated with a combination of 5-fluorouracil, cisplatin, and interferon-α with concurrent external beam radiotherapy. Results. Forty-one (93%) patients completed chemoradiotherapy, with most toxic events recorded as grade I or Ii. Curative resection (all gross tumor removed) was achieved in 36 of 37 surgical explorations, with 10 tumors demonstrating complete pathologic response and 23 showing partial pathologic response. Median follow-up for survivors was 75 months (range, 60-100 months). Five-year survival for all patients was 32%, with a median survival of 28 months. Five-year disease-free survival in patients with curative resection was 36% (median, 26 months) and overall survival was 39% (median, 34 months). Five-year survival for patients with curative resection whose disease responded to chemoradiotherapy was 42% (median overall survival, 36 months). Local-regional recurrence alone occurred in 3 patients, distant failure alone in 12 patients, and combined local-regional and distant failure in 2 patients. A Cox proportionatal hazards model identified both pathologic tumor and nodal stage as independent predictors of disease-free survival. Fourteen patients (32%) were 5-year survivors; 1 of these patients later experienced disease recurrence and died. Conclusions. Preoperative chemoradiotherapy can result in a long-term and durable disease-free state. Only large, multi-institutional phase III trials can determine whether combined modality therapy is superior to resection alone.

Original languageEnglish
Pages (from-to)620-628
Number of pages9
JournalSurgery
Volume130
Issue number4
DOIs
StatePublished - Oct 24 2001
Externally publishedYes

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Chemoradiotherapy
Esophageal Neoplasms
Survival
Disease-Free Survival
Survivors
Recurrence
Esophagogastric Junction
Combined Modality Therapy
Neoplasms
Esophagectomy
Poisons
Proportional Hazards Models
Fluorouracil
Interferons
Cisplatin
Radiotherapy
Clinical Trials
Carcinoma

ASJC Scopus subject areas

  • Surgery

Cite this

Complete 5-year follow-up of a prospective phase II trial of preoperative chemoradiotherapy for esophageal cancer. / Posner, Mitchell C.; Gooding, William E.; Lew, John; Rosenstein, Maury M.; Lembersky, Barry C.

In: Surgery, Vol. 130, No. 4, 24.10.2001, p. 620-628.

Research output: Contribution to journalArticle

Posner, Mitchell C. ; Gooding, William E. ; Lew, John ; Rosenstein, Maury M. ; Lembersky, Barry C. / Complete 5-year follow-up of a prospective phase II trial of preoperative chemoradiotherapy for esophageal cancer. In: Surgery. 2001 ; Vol. 130, No. 4. pp. 620-628.
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abstract = "Background. Conclusive evidence supporting the routine use of multimodality therapy in esophageal cancer is lacking. However, since long-term survival after esophagectomy alone is unusual, clinical trials designed to identify effective therapeutic regimens are essential. We report here the 5-year results of a phase Ii induction chemoradiotherapy trial. Methods. From August 1991 to January 1995, 44 patients with esophageal or gastroesophageal junction carcinoma were treated with a combination of 5-fluorouracil, cisplatin, and interferon-α with concurrent external beam radiotherapy. Results. Forty-one (93{\%}) patients completed chemoradiotherapy, with most toxic events recorded as grade I or Ii. Curative resection (all gross tumor removed) was achieved in 36 of 37 surgical explorations, with 10 tumors demonstrating complete pathologic response and 23 showing partial pathologic response. Median follow-up for survivors was 75 months (range, 60-100 months). Five-year survival for all patients was 32{\%}, with a median survival of 28 months. Five-year disease-free survival in patients with curative resection was 36{\%} (median, 26 months) and overall survival was 39{\%} (median, 34 months). Five-year survival for patients with curative resection whose disease responded to chemoradiotherapy was 42{\%} (median overall survival, 36 months). Local-regional recurrence alone occurred in 3 patients, distant failure alone in 12 patients, and combined local-regional and distant failure in 2 patients. A Cox proportionatal hazards model identified both pathologic tumor and nodal stage as independent predictors of disease-free survival. Fourteen patients (32{\%}) were 5-year survivors; 1 of these patients later experienced disease recurrence and died. Conclusions. Preoperative chemoradiotherapy can result in a long-term and durable disease-free state. Only large, multi-institutional phase III trials can determine whether combined modality therapy is superior to resection alone.",
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N2 - Background. Conclusive evidence supporting the routine use of multimodality therapy in esophageal cancer is lacking. However, since long-term survival after esophagectomy alone is unusual, clinical trials designed to identify effective therapeutic regimens are essential. We report here the 5-year results of a phase Ii induction chemoradiotherapy trial. Methods. From August 1991 to January 1995, 44 patients with esophageal or gastroesophageal junction carcinoma were treated with a combination of 5-fluorouracil, cisplatin, and interferon-α with concurrent external beam radiotherapy. Results. Forty-one (93%) patients completed chemoradiotherapy, with most toxic events recorded as grade I or Ii. Curative resection (all gross tumor removed) was achieved in 36 of 37 surgical explorations, with 10 tumors demonstrating complete pathologic response and 23 showing partial pathologic response. Median follow-up for survivors was 75 months (range, 60-100 months). Five-year survival for all patients was 32%, with a median survival of 28 months. Five-year disease-free survival in patients with curative resection was 36% (median, 26 months) and overall survival was 39% (median, 34 months). Five-year survival for patients with curative resection whose disease responded to chemoradiotherapy was 42% (median overall survival, 36 months). Local-regional recurrence alone occurred in 3 patients, distant failure alone in 12 patients, and combined local-regional and distant failure in 2 patients. A Cox proportionatal hazards model identified both pathologic tumor and nodal stage as independent predictors of disease-free survival. Fourteen patients (32%) were 5-year survivors; 1 of these patients later experienced disease recurrence and died. Conclusions. Preoperative chemoradiotherapy can result in a long-term and durable disease-free state. Only large, multi-institutional phase III trials can determine whether combined modality therapy is superior to resection alone.

AB - Background. Conclusive evidence supporting the routine use of multimodality therapy in esophageal cancer is lacking. However, since long-term survival after esophagectomy alone is unusual, clinical trials designed to identify effective therapeutic regimens are essential. We report here the 5-year results of a phase Ii induction chemoradiotherapy trial. Methods. From August 1991 to January 1995, 44 patients with esophageal or gastroesophageal junction carcinoma were treated with a combination of 5-fluorouracil, cisplatin, and interferon-α with concurrent external beam radiotherapy. Results. Forty-one (93%) patients completed chemoradiotherapy, with most toxic events recorded as grade I or Ii. Curative resection (all gross tumor removed) was achieved in 36 of 37 surgical explorations, with 10 tumors demonstrating complete pathologic response and 23 showing partial pathologic response. Median follow-up for survivors was 75 months (range, 60-100 months). Five-year survival for all patients was 32%, with a median survival of 28 months. Five-year disease-free survival in patients with curative resection was 36% (median, 26 months) and overall survival was 39% (median, 34 months). Five-year survival for patients with curative resection whose disease responded to chemoradiotherapy was 42% (median overall survival, 36 months). Local-regional recurrence alone occurred in 3 patients, distant failure alone in 12 patients, and combined local-regional and distant failure in 2 patients. A Cox proportionatal hazards model identified both pathologic tumor and nodal stage as independent predictors of disease-free survival. Fourteen patients (32%) were 5-year survivors; 1 of these patients later experienced disease recurrence and died. Conclusions. Preoperative chemoradiotherapy can result in a long-term and durable disease-free state. Only large, multi-institutional phase III trials can determine whether combined modality therapy is superior to resection alone.

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