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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

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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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Authors and Affiliations

  1. Ullevaal Hospital, The Norwegian Radium Hospital, and Rikshospitalet, Oslo

    Knut Nygaard M.D., Steinar Hagen M.D., Hanne Sand Hansen M.D., Reidulv Hatlevoll M.D., Ragnar Hultborn M.D., Anders Jakobsen M.D., Matti Mäntyla M.D., Hans Modig M.D., Eva Munck-Wikland M.D., Bengt Rosengren M.D., Johan Tausjø M.D. & Kjell Elgen

  2. Haukeland Hospital, Bergen, Norway

    Knut Nygaard M.D., Steinar Hagen M.D., Hanne Sand Hansen M.D., Reidulv Hatlevoll M.D., Ragnar Hultborn M.D., Anders Jakobsen M.D., Matti Mäntyla M.D., Hans Modig M.D., Eva Munck-Wikland M.D., Bengt Rosengren M.D., Johan Tausjø M.D. & Kjell Elgen

  3. Rigshospitalet, Bispebjerg Hospital, H. Lundbeck A/S and Århus University, Copenhagen, Denmark

    Knut Nygaard M.D., Steinar Hagen M.D., Hanne Sand Hansen M.D., Reidulv Hatlevoll M.D., Ragnar Hultborn M.D., Anders Jakobsen M.D., Matti Mäntyla M.D., Hans Modig M.D., Eva Munck-Wikland M.D., Bengt Rosengren M.D., Johan Tausjø M.D. & Kjell Elgen

  4. Gothenburg University, University Hospital, Umeå

    Knut Nygaard M.D., Steinar Hagen M.D., Hanne Sand Hansen M.D., Reidulv Hatlevoll M.D., Ragnar Hultborn M.D., Anders Jakobsen M.D., Matti Mäntyla M.D., Hans Modig M.D., Eva Munck-Wikland M.D., Bengt Rosengren M.D., Johan Tausjø M.D. & Kjell Elgen

  5. Karolinska Hospital, Stockholm, Sweden

    Knut Nygaard M.D., Steinar Hagen M.D., Hanne Sand Hansen M.D., Reidulv Hatlevoll M.D., Ragnar Hultborn M.D., Anders Jakobsen M.D., Matti Mäntyla M.D., Hans Modig M.D., Eva Munck-Wikland M.D., Bengt Rosengren M.D., Johan Tausjø M.D. & Kjell Elgen

  6. Helsingfors University, Finland

    Knut Nygaard M.D., Steinar Hagen M.D., Hanne Sand Hansen M.D., Reidulv Hatlevoll M.D., Ragnar Hultborn M.D., Anders Jakobsen M.D., Matti Mäntyla M.D., Hans Modig M.D., Eva Munck-Wikland M.D., Bengt Rosengren M.D., Johan Tausjø M.D. & Kjell Elgen

Authors
  1. Knut Nygaard M.D.
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  2. Steinar Hagen M.D.
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  3. Hanne Sand Hansen M.D.
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  4. Reidulv Hatlevoll M.D.
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  5. Ragnar Hultborn M.D.
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  6. Anders Jakobsen M.D.
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  7. Matti Mäntyla M.D.
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  8. Hans Modig M.D.
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  9. Eva Munck-Wikland M.D.
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  10. Bengt Rosengren M.D.
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  11. Johan Tausjø M.D.
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  12. Kjell Elgen
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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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