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Pre-operative radiotherapy prolongs survival in operable esophageal carcinoma: A randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second scandinavian trial in esophageal cancer

Abstract

In a prospective multicenter study, 186 patients with squamous cell esophageal carcinoma, who after evaluation were considered suitable for surgery, were randomized to 4 treatment groups: Group 1, surgery alone; Group 2, pre-operative chemotherapy (cisplatin and bleomycin) and surgery; Group 3, pre-operative irradiation (35 Gy) and surgery; Group 4, pre-operative chemotherapy, radiotherapy, and surgery. Three-year survival was significantly higher in the pooled groups receiving radiotherapy as compared with the pooled groups not receiving radiotherapy. Comparison of the groups having pre-operative chemotherapy with those not having chemotherapy showed no significant difference in survival. Female patients had a significantly better survival than males. The results indicate that pre-operative irradiation had a beneficial effect on intermediate term survival, whereas the chemotherapy regime used did not influence survival.

Résumé

Dans une étude prospective, multicentrique, 186 patients ayant un cancer épidermoïde de l'oesophage ont été randomisée dans quatre groupes: le groupe 1 a eu la chirurgie seule; le groupe 2, une chimiothérapie préopératoire (cis-platine et bléomycine); le groupe 3, une radiothérapie préopératoire suivie de chirurgie; et le groupe 4, une chimiothérapie et une radiothérapie préopératoires suivies de chirurgie. La survie à trois ans a été supérieure chez l'ensemble des patients ayant reçu la radiothérapie préopératoire par rapport à ceux qui n'en ont pas eu. Aucune différence de survie n'a pu être mise en évidence dans les groupes ayant eu ou pas de chimiothérapie. La survie des femmes a été significativement supérieure à celle des hommes. Ces résultats indiquent que la radiothérapie préopératoire apporte un plus en ce qui concerne la survie à moyen terme, alors que la chimiothérapie n'influence pas la survie.

Resumen

En un estudio prospectivo multicéntrico sobre 186 pacientes con carcinoma escamocelular del esófago candidatos para cirugía, se constituyeron cuatro grupos para randomización: Grupo 1, cirugía solamente; Grupo 2, quimioterapia preoperatoria (cisplatino y bleomicina) y cirugía; Grupo 3, irradiación preoperatoria (35 Gy) y cirugía; Grupo 4, quimioterapia preoperatoria, radioterapia y cirugía. La comparación entre el grupo que recibió quimioterapia y el que no la recibió no demostró diferencia significativa en cuanto a supervivencia. Las pacientes femeninas exhibieron una mejor supervivencia que los pacientes masculinos. Los resultados indican que la irradiación preoperatoria tuvo un efecto benéfico sobre la sobrevida a término medio, en tanto que la quimioterapia, en el regimen utilizado, no tuvo influencia sobre la supervivencia.

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References

  1. 1.

    Launois, B., Delarue, D., Campion, J.P., Kerbaol, M.: Preoperative radiotherapy for carcinoma of the esophagus. Surg. Gynecol. Obstet.153:690, 1981

  2. 2.

    Coonley, C.J., Bains, M., Hilaris, B., Chapman, R., Kelsen, D.P.: Cisplatin and bleomycin in the treatment of esophageal carcinoma: A final report. Cancer54:2351, 1984

  3. 3.

    Leichman, L., Steiger, Z., Seydel, H.G., Dinogru, A., Kinzie, J., Toben, S., MacKenzie, G., Shell, J.: Preoperative chemotherapy and radiation therapy for patients with cancer of the esophagus: A potentially curative approach. J. Clin. Oncol.2:75, 1984

  4. 4.

    Wilson, S.E., Hiatt, J.R., Stabile, B.E., Williams, R.A.: Cancer of the distal esophagus and cardia: Preoperative irradiation prolongs survival. Am. J. Surg.150:114, 1985

  5. 5.

    Huang, G.-J., Xian-Zhi, G., Liang-Jun, W., Wei-Bo, Y., Ru-Gang, Z., Zhang, L.-J., Zhang, D.-W., Zhang, Z.-X., Wang, Z.-Y., Yang, K.: Experience with combined preoperative irradiation and surgery for carcinoma of the esophagus. Cancer Res.31:159, 1986

  6. 6.

    Popp, M.B., Hawley, D., Reising, J., Bongiovanni, G., Weesner, R., Moomaw, C.J., Martelo, O., Aron, B.: Improved survival in squamous esophageal cancer. Arch. Surg.121:1330, 1986

  7. 7.

    Gignoux, M., Roussel, A., Paillot, B., Gillet, M., Schlag, P., Favre, J.-P., Dalesio, O., Buyse, M., Duez, N.: The value of preoperative radiotherapy in esophageal cancer: Results of a study of the E.O.R.T.C. World J. Surg.11:426, 1987

  8. 8.

    Hilgenberg, A.D., Carey, R.W., Wilkins, E.W. Jr., Choi, N.C., Mathisen, D.J., Grillo, H.C.: Preoperative chemotherapy, surgical resection, and selective postoperative therapy for squamous cell carcinoma of the esophagus. Ann. Thorac. Surg.45:357, 1988

  9. 9.

    Parker, E.F., Reed, C.E., Marks, R.D., Kratz, J.M., Connolly, M.: Chemotherapy, radiation therapy, and resection for carcinoma of the esophagus: Long-term results. J. Thorac. Cardiovasc. Surg.98:1037, 1989

  10. 10.

    Roth, J.A., Pass, H.I., Flanagan, M.M., Graeber, G.M., Rosenberg, J.C., Steinberg, S.: Randomized clinical trial of preoperative and postoperative adjuvant chemotherapy with cisplatin, vindesine, and bleomycin for carcinoma of the esophagus. J. Thorac. Cardiovasc. Surg.96:242, 1988

  11. 11.

    Orringer, M.B., Forastiere, A.A., Perez-Tamayo, C., Urba, A., Takasugi, B.J., Bromberg, J.: Chemotherapy and radiation therapy before transhiatal esophagectomy for esophageal carcinoma. Ann. Thorac. Surg.49:348, 1990

  12. 12.

    Andersen, A.P., Berdal, P., Edsmyr, F., Hagen, S., Hatlevoll, R., Nygaard, K., Ottosen, P., Peterffy, P., Kongsholm, H., Elgen, K.: Irradiation, chemotherapy and surgery in esophageal cancer: Randomized clinical study. The first Scandinavian trial in esophageal cancer. Radiother. Oncol.2:179, 1984

  13. 13.

    Peto, R.: Clinical trial methodology. Biomedicine28:24, 1978

  14. 14.

    Peto, R., Pike, M.C.: Conservatism of the approximation (O.E)2/E in the logrank test for survival data or tumour incidence data. Biometrics29:579, 1973

  15. 15.

    Fowler, J.F.: The linear-quadratic formula and progress in fractionated radiotherapy. Br. J. Radiol.62:674, 1989

  16. 16.

    Withers, H.R., Taylor, J.M.G., Maciejewski, B.: The hazard of accelerated tumor clonogen repopulation during radiotherapy. Acta Oncol.27:131, 1988

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Correspondence to Knut Nygaard M.D..

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Nygaard, K., Hagen, S., Hansen, H.S. et al. Pre-operative radiotherapy prolongs survival in operable esophageal carcinoma: A randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second scandinavian trial in esophageal cancer. World J. Surg. 16, 1104–1109 (1992). https://doi.org/10.1007/BF02067069

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Keywords

  • Esophageal Cancer
  • Multicenter Study
  • Chemotherapy Regime
  • Bleomycin
  • Esophageal Carcinoma