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Previous Volume 335:462-467 August 15, 1996 Number 7 Next

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ABSTRACT

Background Uncontrolled studies suggest that a combination of chemotherapy and radiotherapy improves the survival of patients with esophageal adenocarcinoma. We conducted a prospective, randomized trial comparing surgery alone with combined chemotherapy, radiotherapy, and surgery.

Methods Patients assigned to multimodal therapy received two courses of chemotherapy in weeks 1 and 6 (fluorouracil, 15 mg per kilogram of body weight daily for five days, and cisplatin, 75 mg per square meter of body-surface area on day 7) and a course of radiotherapy (40 Gy, administered in 15 fractions over a three-week period, beginning concurrently with the first course of chemotherapy), followed by surgery. The patients assigned to surgery had no preoperative therapy.

Results Of the 58 patients assigned to multimodal therapy and the 55 assigned to surgery, 10 and 1, respectively, were withdrawn for protocol violations. At the time of surgery, 23 of 55 patients (42 percent) treated with preoperative multimodal therapy who could be evaluated had positive nodes or metastases, as compared with 45 of the 55 patients (82 percent) who underwent surgery alone (P<0.001). Thirteen of the 52 patients (25 percent) who underwent surgery after multimodal therapy had complete responses, as determined pathologically. The median survival of patients assigned to multimodal therapy was 16 months, as compared with 11 months for those assigned to surgery alone (P = 0.01). At one, two, and three years, 52, 37, and 32 percent, respectively, of patients assigned to multimodal therapy were alive, as compared with 44, 26, and 6 percent of those assigned to surgery, with the survival advantage favoring multimodal therapy reaching significance at three years (P = 0.01).

Conclusions Multimodal treatment is superior to surgery alone for patients with resectable adenocarcinoma of the esophagus.

Source Information

From the Departments of Surgery (T.N.W., T.P.J.H.) and Gastroenterology (N.N., N.K.), St. James's Hospital; the Department of Radiotherapy, St. Luke's Hospital (D.H.); and the Departments of Community Health and Statistics, Trinity College (A.K.) — all in Dublin, Ireland.

Address reprint requests to Dr. Walsh at the Department of Surgery, Beaumont Hospital, Dublin 9, Ireland.

Full Text of this Article

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Multimodal Therapy for Esophageal Adenocarcinoma
Badwe R. A., Vaidya J. S., Bhansali M. S., Gaffney P., Funk E. M., Witte J., Walsh T. N., Kelly A., Hennessy T. P.J.
Extract | Full Text  
N Engl J Med 1997; 336:374-376, Jan 30, 1997. Correspondence

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