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Multicenter prospective randomized trial comparing standard esophagectomy with chemoradiotherapy for treatment of squamous esophageal cancer: Early results from the Chinese University Research Group for Esophageal Cancer (CURE)

  • Published:
Journal of Gastrointestinal Surgery

Abstract

We conducted a prospective randomized trial to compare the efficacy and survival outcome by chemoradiation with that by esophagectomy as a curative treatment. From July 2000 to December 2004, 80 patients with potentially resectable squamous cell carcinoma of the mid or lower thoracic esophagus were randomized to esophagectomy or chemoradiotherapy. A two-or three-stage esophagectomy with two-field dissection was performed. Patients treated with chemoradiotherapy received continuous 5-.uorouracil infusion (200 mg/m2/day) from day 1 to 42 and cisplatin (60 mg/m2) on days 1 and 22. The tumor and regional lymphatics were concomitantly irradiated to a total of 50–60 Gy.Tumor response was assessed by endoscopy, endoscopic ultrasonography, and computed tomography scan. Salvage esophagectomy was performed for incomplete response or recurrence. Forty-four patients received standard esophagectomy, whereas 36 were treated with chemoradiotherapy. Median follow-up was 16.9 months. The operative mortality was 6.8%. The incidence of postoperative complications was 38.6%. No difference in the early cumulative survival was found between the two groups (RR = 0.89; 95% confidence interval, 0.37-2.17; log-rank test P =0.45). There was no difference in the disease-free survival. Patients treated with surgery had a slightly higher proportion of recurrence in the mediastinum, whereas those treated with chemoradiation sustained a higher proportion of recurrence in the cervical or abdominal regions. Standard esophagectomy or chemoradiotherapy offered similar early clinical outcome and survival for patients with squamous cell carcinoma of the esophagus. The challenge lies in the detection of residue disease after chemoradiotherapy.

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Authors and Affiliations

  1. Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32, Ngan Shing Street, Shatin, N.T., Hong Kong

    Philip W. Y. Chiu M.B.Ch.B., F.R.C.S.Ed.(Gen), F.C.S.H.K., F.H.K.A.M., Alex C. M. Au-Yeung M.Med.Sc.,  Sydney C. S. Chung M.D., F.R.C.S.Ed., F.R.C.S.(Glas), F.R.C.P.Ed., F.C.S.H.K., F.H.K.A.M. & Enders K. W. Ng M.D., M.B.Ch.B., F.R.C.S.Ed.(Gen), F.C.S.H.K., F.H.K.A.M.

  2. Department of Surgery, Northern District Hospital, Hong Kong, S.A.R.

    Angus C. W. Chan M.D., M.B.Ch.B., F.R.C.S.Ed.(Gen), F.C.S.H.K., F.H.K.A.M. & H. T. Leong M.B.B.S.(HK), F.R.C.S.(Ed), F.H.K.A.M.(Surg), F.C.S.H.K.

  3. Department of Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, S.A.R.

    S. F. Leung F.R.C.R.

  4. Department of Surgery, United Christian Hospital, Hong Kong, S.A.R.

    K. H. Kwong M.B.Ch.B., F.R.C.S.Ed.(Gen), F.C.S.H.K., F.H.K.A.M.

  5. Department of Surgery, Pamela Youde Nethersole Hospital, Hong Kong, S.A.R.

    Micheal K. W. Li M.B.B.S.(Lond), M.R.C.S.(Eng), L.R.C.P.(Lond), F.R.C.S.(Eng), F.R.C.S.(Edin), F.C.S.H.K., F.H.K.A.M.(Surg)

Authors
  1. Philip W. Y. Chiu M.B.Ch.B., F.R.C.S.Ed.(Gen), F.C.S.H.K., F.H.K.A.M.
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  2. Angus C. W. Chan M.D., M.B.Ch.B., F.R.C.S.Ed.(Gen), F.C.S.H.K., F.H.K.A.M.
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  3. S. F. Leung F.R.C.R.
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  4. H. T. Leong M.B.B.S.(HK), F.R.C.S.(Ed), F.H.K.A.M.(Surg), F.C.S.H.K.
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  5. K. H. Kwong M.B.Ch.B., F.R.C.S.Ed.(Gen), F.C.S.H.K., F.H.K.A.M.
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  6. Micheal K. W. Li M.B.B.S.(Lond), M.R.C.S.(Eng), L.R.C.P.(Lond), F.R.C.S.(Eng), F.R.C.S.(Edin), F.C.S.H.K., F.H.K.A.M.(Surg)
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  7. Alex C. M. Au-Yeung M.Med.Sc.
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  8. Sydney C. S. Chung M.D., F.R.C.S.Ed., F.R.C.S.(Glas), F.R.C.P.Ed., F.C.S.H.K., F.H.K.A.M.
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  9. Enders K. W. Ng M.D., M.B.Ch.B., F.R.C.S.Ed.(Gen), F.C.S.H.K., F.H.K.A.M.
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Corresponding author

Correspondence to Enders K. W. Ng M.D., M.B.Ch.B., F.R.C.S.Ed.(Gen), F.C.S.H.K., F.H.K.A.M..

Additional information

This study was supported by the Research Grant Council (RGC) of Hong Kong Special Administrative Region, China.

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Chiu, P.W.Y., Chan, A.C.W., Leung, S.F. et al. Multicenter prospective randomized trial comparing standard esophagectomy with chemoradiotherapy for treatment of squamous esophageal cancer: Early results from the Chinese University Research Group for Esophageal Cancer (CURE). J Gastrointest Surg 9, 794–802 (2005). https://doi.org/10.1016/j.gassur.2005.05.005

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