Neoadjuvant treatment of advanced stage esophageal adenocarcinoma increases survival.
Sophisticated surgical approaches have a definite but limited role in esophageal cancer. The majority have systemic disease at presentation, minimal residual disease following resection or co-morbid conditions that preclude extensive surgery. This paper examines whether neoadjuvant therapy is effective in advanced-stage disease. A randomized trial, closing September 1995, was followed up to determine results at 5 years. All patients were followed up for more than 5 years. Median survival, based on intention-to-treat, was 17 months for multimodal therapy vs. 12 months for surgery alone (P=0.002). Survival based on treatment received was 27 months vs. 14 months (P=0.0006). Multimodal therapy enhances survival for patients with minimal residual disease. This is consistent with the literature. Under-powered trials cannot prove a real difference to be significant. Future trials should target patients with minimal residual disease.
Walsh
T N
TN
Royal College of Surgeons Department of Surgery, James Connolly Memorial Hospital, Blanchardstown, Dublin 15, Ireland. tnwalsh@indigo.ie
Grennell
M
M
Mansoor
S
S
Kelly
A
A
D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery*; D002299:Cardia; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000401:mortality* / Q000601:surgery*; D016896:Treatment Outcome