Gastrointestinal Cancer

SS 07 - GI 1 - Gastric/GE Junction

58 - Phase III Randomized Study of Preoperative Versus Postoperative Chemoradiotherapy in Resectable Locally Advanced Esophageal Squamous Cell Carcinoma

Monday, October 22
8:15 AM - 8:25 AM
Location: Room 214 A/B

Phase III Randomized Study of Preoperative Versus Postoperative Chemoradiotherapy in Resectable Locally Advanced Esophageal Squamous Cell Carcinoma
Y. Xu1,2, Q. Chen3, X. Sun4, J. Liu3, Y. Jiang2, P. Ye5, Q. Wei6, X. Zhou2, and W. Mao7; 1Shanghai Pulmonary Hospital, Shanghai, China, 2Zhejiang Cancer Hospital, Hangzhou, China, 3Department of Thoracic Oncology, Zhejiang Cancer Hospital, Hangzhou, China, 4Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China, 5The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China, 6Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, 7Zhejiang Key Laboratory of the Diagnosis & Treatment Technology on Thoracic Oncology, Hangzhou, China

Purpose/Objective(s): The role of preoperative chemoradiation (CRT) in the treatment of patients with esophageal squamous cell carcinoma (SCC) is not well established; postoperative CRT is still widely used in some areas worldwide. We randomly compared preoperative CRT followed by surgery with surgery followed by postoperative CRT in an Asian population.

Materials/Methods: Patients with clinically resectable, locally advanced (cT1-2N1M0 or T3–4N0–1M0) SCC of the esophagus were randomly assigned to receive either preoperative CRT (weekly administration of carboplatin/paclitaxel for 6 weeks and concurrent radiation therapy 50.4 Gy) followed by surgery, or surgery followed by concurrent postoperative CRT (initially the same regimen as preoperative CRT). However, concurrent postoperative CRT was modified to sequential chemoradiation (carboplatin/paclitaxel per 3 weeks for 2 cycles followed by radiation therapy 50.4 Gy) due to toxicity-related poor compliance. The primary endpoint was 3-year overall survival (OS), analysed by intention-to-treat.

Results: Accrual goal was reached; 149 patients were randomized: 74 to preoperative CRT and 75 to postoperative CRT (April 2012 to November 2015). After median follow-up of 42 months, preoperative CRT significantly improved 3-year disease-free survival (56.2% vs. 34.5%, HR 0.556 [95% CI 0.355-0.870], p = 0.008) and OS (63.8% vs. 49.0%, HR 0.560 [95% CI 0.360-0.996], p = 0.044) compared with postoperative CRT. There was a trend towards an improved R0 resection rate after preoperative CRT compared with postoperative CRT (95% vs. 87%, p =0.076). Postoperative complications and grade 3-4 CRT-related toxicities were not significantly different. In-hospital mortality was 5% and 1% for preoperative and postoperative CRT (p = 0.337).

Conclusion: Preoperative CRT, as compared with postoperative CRT, prolongs DFS and OS with acceptable toxicities in resectable locally-advanced esophageal SCC.

Author Disclosure: Y. Xu: None. Q. Chen: None. X. Sun: None. Y. Jiang: None.

Yaping Xu

Disclosure:
No relationships to disclose.

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58 - Phase III Randomized Study of Preoperative Versus Postoperative Chemoradiotherapy in Resectable Locally Advanced Esophageal Squamous Cell Carcinoma



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