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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.

Publication ,  Journal Article
Kelsen, DP; Winter, KA; Gunderson, LL; Mortimer, J; Estes, NC; Haller, DG; Ajani, JA; Kocha, W; Minsky, BD; Roth, JA; Willett, CG ...
Published in: J Clin Oncol
August 20, 2007

PURPOSE: We update Radiation Therapy Oncology Group trial 8911 (USA Intergroup 113), a comparison of chemotherapy plus surgery versus surgery alone for patients with localized esophageal cancer. The relationship between resection type and between tumor response and outcome were also analyzed. PATIENTS AND METHODS: The chemotherapy group received preoperative cisplatin plus fluorouracil. Outcome based on the type of resection (R0, R1, R2, or no resection) was evaluated. The main end point was overall survival. Disease-free survival, relapse pattern, the influence of postoperative treatment, and the relationship between response to preoperative chemotherapy and outcome were also evaluated. RESULTS: Two hundred sixteen patients received preoperative chemotherapy, 227 underwent immediate surgery. Fifty-nine percent of surgery only and 63% of chemotherapy plus surgery patients underwent R0 resections (P = .5137). Patients undergoing less than an R0 resection had an ominous prognosis; 32% of patients with R0 resections were alive and free of disease at 5 years, only 5% of patients undergoing an R1 resection survived for longer than 5 years. The median survival rates for patients with R1, R2, or no resections were not significantly different. While, as initially reported, there was no difference in overall survival for patients receiving perioperative chemotherapy compared with the surgery only group, patients with objective tumor regression after preoperative chemotherapy had improved survival. CONCLUSION: For patients with localized esophageal cancer, whether or not preoperative chemotherapy is administered, only an R0 resection results in substantial long-term survival. Even microscopically positive margins are an ominous prognostic factor. After a R1 resection, postoperative chemoradiotherapy therapy offers the possibility of long-term disease-free survival to a small percentage of patients.

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Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

August 20, 2007

Volume

25

Issue

24

Start / End Page

3719 / 3725

Location

United States

Related Subject Headings

  • Survival Rate
  • Oncology & Carcinogenesis
  • Neoadjuvant Therapy
  • Middle Aged
  • Male
  • Humans
  • Fluorouracil
  • Female
  • Esophagectomy
  • Esophageal Neoplasms
 

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Kelsen, D. P., Winter, K. A., Gunderson, L. L., Mortimer, J., Estes, N. C., Haller, D. G., … USA Intergroup, . (2007). 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, 25(24), 3719–3725. https://doi.org/10.1200/JCO.2006.10.4760
Kelsen, David P., Katryn A. Winter, Leonard L. Gunderson, Joanne Mortimer, Norman C. Estes, Daniel G. Haller, Jaffer A. Ajani, 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 25, no. 24 (August 20, 2007): 3719–25. https://doi.org/10.1200/JCO.2006.10.4760.
Kelsen, David P., 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, vol. 25, no. 24, Aug. 2007, pp. 3719–25. Pubmed, doi:10.1200/JCO.2006.10.4760.
Kelsen DP, Winter KA, Gunderson LL, Mortimer J, Estes NC, Haller DG, Ajani JA, Kocha W, Minsky BD, Roth JA, Willett CG, Radiation Therapy Oncology Group, USA Intergroup. 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. 2007 Aug 20;25(24):3719–3725.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

August 20, 2007

Volume

25

Issue

24

Start / End Page

3719 / 3725

Location

United States

Related Subject Headings

  • Survival Rate
  • Oncology & Carcinogenesis
  • Neoadjuvant Therapy
  • Middle Aged
  • Male
  • Humans
  • Fluorouracil
  • Female
  • Esophagectomy
  • Esophageal Neoplasms