This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bedenne, L. Articles by Binquet, C. Search for Related Content PubMed PubMed Citation Articles by Bedenne, L. Articles by Binquet, C. Related Articles Related Editorial Related Correspondence Social Bookmarking                            What's this?

Chemoradiation Followed by Surgery Compared With Chemoradiation Alone in Squamous Cancer of the Esophagus: FFCD 9102

Laurent Bedenne, Pierre Michel, Olivier Bouché, Chantal Milan, Christophe Mariette, Thierry Conroy, Denis Pezet, Bernard Roullet, Jean-François Seitz, Jean-Philippe Herr, Bernard Paillot, Patrick Arveux, Franck Bonnetain, Christine Binquet

From the University Hospital Le Bocage; Anticancer Center Georges-François Leclerc, Dijon; University Hospital Charles-Nicolle, Rouen; University Hospital Robert-Debré, Reims; University Hospital Claude-Huriez, Lille; Anticancer Center Alexis Vautrin, Vandoeuvre; University Hospital Hôtel-Dieu, Clermont-Ferrand; University Hospital Dupuytren, Limoges; Université de la Méditerranée, Marseille; and Clinique Sainte-Marie, Chalon, France

Address reprint requests to Laurent Bedenne, MD, Fédération Francophone de Cancérologie Digestive, Faculté de Médecine, BP 87900, 21079 Dijon-Cedex, France; e-mail: lbedenne{at}u-bourgogne.fr

Purpose Uncontrolled studies suggest that chemoradiation has similar efficacy as surgery for esophageal cancer. Therefore, a randomized trial was carried out to compare, in responders only, chemoradiation alone with chemoradiation followed by surgery in patients with locally advanced tumors.

Patients and Methods Eligible patients had operable T3N0-1M0 thoracic esophageal cancer. Patients received two cycles of fluorouracil (FU) and cisplatin (days 1 to 5 and 22 to 26) and either conventional (46 Gy in 4.5 weeks) or split-course (15 Gy, days 1 to 5 and 22 to 26) concomitant radiotherapy. Patients with response and no contraindication to either treatment were randomly assigned to surgery (arm A) or continuation of chemoradiation (arm B; three cycles of FU/cisplatin and either conventional [20 Gy] or split-course [15 Gy] radiotherapy). Chemoradiation was considered equivalent to surgery if the difference in 2-year survival rate was less than 10%.

Results Of 444 eligible patients, 259 were randomly assigned; 230 patients (88.8%) had epidermoid cancer, and 29 (11.2%) had glandular carcinoma. Two-year survival rate was 34% in arm A versus 40% in arm B (hazard ratio for arm B v arm A = 0.90; adjusted P = .44). Median survival time was 17.7 months in arm A compared with 19.3 months in arm B. Two-year local control rate was 66.4% in arm A compared with 57.0% in arm B, and stents were less required in the surgery arm (5% in arm A v 32% in arm B; P < .001). The 3-month mortality rate was 9.3% in arm A compared with 0.8% in arm B (P = .002). Cumulative hospital stay was 68 days in arm A compared with 52 days in arm B (P = .02).

Conclusion Our data suggest that, in patients with locally advanced thoracic esophageal cancers, especially epidermoid, who respond to chemoradiation, there is no benefit for the addition of surgery after chemoradiation compared with the continuation of additional chemoradiation.

Supported by grants from the Ligue Nationale Contre le Cancer, the Fonds de Recherche de la Société Nationale Française de Gastroentérologie, the Programme Hospitalier pour la Recherche Clinique, and the Association pour la Recherche Contre le Cancer.

Presented in part at the 38th Annual Meeting of the American Society of Clinical Oncology, May 18-21, 2002, Orlando, FL, and the 27th Annual Journées Francophones de Pathologie Digestive, March 31-April 2, 2003, Paris, France.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Editorial

• Surgery After Primary Chemoradiotherapy in Squamous Cancer of the Esophagus: Is the Photon Mightier Than the Sword?
  David H. Ilson
  JCO 2007 25: 1155-1156 [Full Text]

Related Correspondence

• Is Surgery Still Part of Local Therapy in Patients With Locally Advanced Esophageal Carcinoma?
  Thomas Ruhstaller, Beat Thuerlimann, Dieter Koeberle, and Roger von Moos
  JCO 2007 25: 4025-4026 [Full Text]

This article has been cited by other articles:

				D.G. Power and D.H. Ilson Review: Integration of targeted agents in the neo-adjuvant treatment of gastro-esophageal cancers Therapeutic Advances in Medical Oncology, November 1, 2009; 1(3): 145 - 165. [Abstract] [PDF]

				T. Ruhstaller, L. Widmer, J. C. Schuller, A. Roth, V. Hess, W. Mingrone, R. von Moos, M. Borner, B. C. Pestalozzi, S. BalmerMajno, et al. Multicenter phase II trial of preoperative induction chemotherapy followed by chemoradiation with docetaxel and cisplatin for locally advanced esophageal carcinoma (SAKK 75/02) Ann. Onc., September 1, 2009; 20(9): 1522 - 1528. [Abstract] [Full Text] [PDF]

				C. G. Willett and B. G. Czito Combined-modality Therapy for Esophageal Cancer ASCO Educational Book, January 1, 2009; 2009(1): 243 - 249. [Abstract] [Full Text] [PDF]

				E. C. Paulson, J. Ra, K. Armstrong, C. Wirtalla, F. Spitz, and R. R. Kelz Underuse of Esophagectomy as Treatment for Resectable Esophageal Cancer Arch Surg, December 1, 2008; 143(12): 1198 - 1203. [Abstract] [Full Text] [PDF]

				X.-B. D'Journo, P. Michelet, L. Dahan, C. Doddoli, J.-F. Seitz, R. Giudicelli, P. A. Fuentes, and P. A. Thomas Indications and outcome of salvage surgery for oesophageal cancer Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 1117 - 1123. [Abstract] [Full Text] [PDF]

				D. H. Ilson Combined Modality Therapy for Gastric, Esophageal, and Gastroesophageal Junction Cancers ASCO Educational Book, January 1, 2008; 2008(1): 177 - 182. [Abstract] [Full Text] [PDF]

				G. Crehange, P. Maingon, K. Peignaux, T. D. N'guyen, X. Mirabel, C. Marchal, P. Verrelle, B. Roullet, F. Bonnetain, and L. Bedenne Phase III Trial of Protracted Compared With Split-Course Chemoradiation for Esophageal Carcinoma: Federation Francophone de Cancerologie Digestive 9102 J. Clin. Oncol., November 1, 2007; 25(31): 4895 - 4901. [Abstract] [Full Text] [PDF]

				L. Kleinberg and A. A. Forastiere Chemoradiation in the Management of Esophageal Cancer J. Clin. Oncol., September 10, 2007; 25(26): 4110 - 4117. [Abstract] [Full Text] [PDF]

				T. Ruhstaller, B. Thuerlimann, D. Koeberle, and R. von Moos Is Surgery Still Part of Local Therapy in Patients With Locally Advanced Esophageal Carcinoma? J. Clin. Oncol., September 1, 2007; 25(25): 4025 - 4026. [Full Text] [PDF]

				L. Bedenne and F. Bonnetain In Reply J. Clin. Oncol., September 1, 2007; 25(25): 4026 - 4027. [Full Text] [PDF]

				D. P. Kelsen, K. A. Winter, L. L. Gunderson, J. Mortimer, N. C. Estes, D. G. Haller, J. A. Ajani, W. Kocha, B. D. Minsky, J. A. Roth, et al. Long-Term Results of RTOG Trial 8911 (USA Intergroup 113): A Random Assignment Trial Comparison of Chemotherapy Followed by Surgery Compared With Surgery Alone for Esophageal Cancer J. Clin. Oncol., August 20, 2007; 25(24): 3719 - 3725. [Abstract] [Full Text] [PDF]

				D. H. Ilson Surgery After Primary Chemoradiotherapy in Squamous Cancer of the Esophagus: Is the Photon Mightier Than the Sword? J. Clin. Oncol., April 1, 2007; 25(10): 1155 - 1156. [Full Text] [PDF]