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Open Access Research article

Chemotherapy followed by surgery versus surgery alone in patients with resectable oesophageal squamous cell carcinoma: Long-term results of a randomized controlled trial

Jurjen J Boonstra12*, Tjebbe C Kok3, Bas PL Wijnhoven2, Mark van Heijl4, Mark I van Berge Henegouwen4, Fiebo JW ten Kate5, Peter D Siersema6, Winand NM Dinjens1, Jan JB van Lanschot2, Hugo W Tilanus2 and Ate van der Gaast7

Author Affiliations

1 Department of Pathology, Josephine Nefkens Institute, Erasmus MC, University Medical Center, Rotterdam, The Netherlands

2 Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands

3 Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands

4 Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands

5 Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands

6 Department of Gastroenterology and Hepatology6, University Medical Center Utrecht, Utrecht, The Netherlands

7 Department of Internal Medicine, Josephine Nefkens Institute, Erasmus MC, University Medical Center, Rotterdam, The Netherlands

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BMC Cancer 2011, 11:181  doi:10.1186/1471-2407-11-181

Published: 19 May 2011

Abstract

Background

This is a randomized, controlled trial of preoperative chemotherapy in patients undergoing surgery for oesophageal squamous cell carcinoma (OSCC). Patients were allocated to chemotherapy, consisting of 2-4 cycles of cisplatin and etoposide, followed by surgery (CS group) or surgery alone (S group). Initial results reported only in abstract form in 1997, demonstrated an advantage for overall survival in the CS group. The results of this trial have been updated and discussed in the timeframe in which this study was performed.

Methods

This trial recruited 169 patients with OSCC, 85 patients assigned to preoperative chemotherapy and 84 patients underwent immediate surgery. The primary study endpoint was overall survival (OS), secondary endpoints were disease free survival (DFS) and pattern of failure. Survival has been determined from Kaplan-Meier curves and treatment comparisons made with the log-rank test.

Results

There were 148 deaths, 71 in the CS and 77 in the S group. Median OS time was 16 months in the CS group compared with 12 months in the S group; 2-year survival rates were 42% and 30%; and 5-year survival rates were 26% and 17%, respectively. Intention to treat analysis showed a significant overall survival benefit for patients in the CS group (P = 0.03, by the log-rank test; hazard ratio [HR] 0.71; 95%CI 0.51-0.98). DFS (from landmark time of 6 months after date of randomisation) was also better in the CS-group than in the S group (P = 0.02, by the log-rank test; HR 0.72; 95%CI 0.52-1.0). No difference in failure pattern was observed between both treatment arms.

Conclusions

Preoperative chemotherapy with a combination of etoposide and cisplatin significantly improved overall survival in patients with OSCC.