Journal ArticleDOI
Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial
Joel Shapiro,J. Jan B. van Lanschot,Maarten C.C.M. Hulshof,Pieter van Hagen,Mark I. van Berge Henegouwen,Bas P. L. Wijnhoven,Hanneke W. M. van Laarhoven,Grard A. P. Nieuwenhuijzen,Geke A. P. Hospers,Johannes J. Bonenkamp,Miguel A. Cuesta,Reinoud J. B. Blaisse,Olivier R. Busch,Fiebo J. W. ten Kate,Geert-Jan Creemers,Cornelis J. A. Punt,John T. M. Plukker,Henk M.W. Verheul,Ernst Jan Spillenaar Bilgen,Herman van Dekken,Maurice J.C. van der Sangen,Tom Rozema,Katharina Biermann,Jannet C. Beukema,Anna H.M. Piet,Caroline M. van Rij,Janny G. Reinders,Hugo W. Tilanus,Ewout W. Steyerberg,Ate van der Gaast +29 more
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Long-term follow-up confirms the overall survival benefits for neoadjuvant chemoradiotherapy in patients with clinically resectable, locally advanced cancer of the oesophagus or Oesophagogastric junction and shows a significant increase in 5-year overall survival.Abstract:
Summary Background Initial results of the ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) comparing neoadjuvant chemoradiotherapy plus surgery versus surgery alone in patients with squamous cell carcinoma and adenocarcinoma of the oesophagus or oesophagogastric junction showed a significant increase in 5-year overall survival in favour of the neoadjuvant chemoradiotherapy plus surgery group after a median of 45 months' follow-up. In this Article, we report the long-term results after a minimum follow-up of 5 years. Methods Patients with clinically resectable, locally advanced cancer of the oesophagus or oesophagogastric junction (clinical stage T1N1M0 or T2–3N0–1M0, according to the TNM cancer staging system, sixth edition) were randomly assigned in a 1:1 ratio with permuted blocks of four or six to receive either weekly administration of five cycles of neoadjuvant chemoradiotherapy (intravenous carboplatin [AUC 2 mg/mL per min] and intravenous paclitaxel [50 mg/m 2 of body-surface area] for 23 days) with concurrent radiotherapy (41·4 Gy, given in 23 fractions of 1·8 Gy on 5 days per week) followed by surgery, or surgery alone. The primary endpoint was overall survival, analysed by intention-to-treat. No adverse event data were collected beyond those noted in the initial report of the trial. This trial is registered with the Netherlands Trial Register, number NTR487, and has been completed. Findings Between March 30, 2004, and Dec 2, 2008, 368 patients from eight participating centres (five academic centres and three large non-academic teaching hospitals) in the Netherlands were enrolled into this study and randomly assigned to the two treatment groups: 180 to surgery plus neoadjuvant chemoradiotherapy and 188 to surgery alone. Two patients in the neoadjuvant chemoradiotherapy group withdrew consent, so a total of 366 patients were analysed (178 in the neoadjuvant chemoradiotherapy plus surgery group and 188 in the surgery alone group). Of 171 patients who received any neoadjuvant chemoradiotherapy in this group, 162 (95%) were able to complete the entire neoadjuvant chemoradiotherapy regimen. After a median follow-up for surviving patients of 84·1 months (range 61·1–116·8, IQR 70·7–96·6), median overall survival was 48·6 months (95% CI 32·1–65·1) in the neoadjuvant chemoradiotherapy plus surgery group and 24·0 months (14·2–33·7) in the surgery alone group (HR 0·68 [95% CI 0·53–0·88]; log-rank p=0·003). Median overall survival for patients with squamous cell carcinomas was 81·6 months (95% CI 47·2–116·0) in the neoadjuvant chemoradiotherapy plus surgery group and 21·1 months (15·4–26·7) in the surgery alone group (HR 0·48 [95% CI 0·28–0·83]; log-rank p=0·008); for patients with adenocarcinomas, it was 43·2 months (24·9–61·4) in the neoadjuvant chemoradiotherapy plus surgery group and 27·1 months (13·0–41·2) in the surgery alone group (HR 0·73 [95% CI 0·55–0·98]; log-rank p=0·038). Interpretation Long-term follow-up confirms the overall survival benefits for neoadjuvant chemoradiotherapy when added to surgery in patients with resectable oesophageal or oesophagogastric junctional cancer. This improvement is clinically relevant for both squamous cell carcinoma and adenocarcinoma subtypes. Therefore, neoadjuvant chemoradiotherapy according to the CROSS trial followed by surgical resection should be regarded as a standard of care for patients with resectable locally advanced oesophageal or oesophagogastric junctional cancer. Funding Dutch Cancer Foundation (KWF Kankerbestrijding).read more
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Esophageal and Esophagogastric Junction Cancers, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology.
Jaffer A. Ajani,Thomas A. D'Amico,David J. Bentrem,Joseph Chao,Carlos U. Corvera,Prajnan Das,Crystal S. Denlinger,Peter C. Enzinger,Paul T. Fanta,Farhood Farjah,Hans Gerdes,Michael Gibson,Robert E. Glasgow,James A. Hayman,Steven N. Hochwald,Wayne L. Hofstetter,David H. Ilson,Dawn E. Jaroszewski,Kimberly L. Johung,Rajesh N. Keswani,Lawrence Kleinberg,Stephen Leong,Quan P. Ly,Kristina A. Matkowskyj,Michael McNamara,Mary F. Mulcahy,Ravi Kumar Paluri,Haeseong Park,Kyle A. Perry,Jose M. Pimiento,George A. Poultsides,Robert E. Roses,Vivian E. Strong,Georgia L. Wiesner,Christopher G. Willett,Cameron D. Wright,Nicole R. McMillian,Lenora A. Pluchino +37 more
TL;DR: This selection from the NCCN Guidelines for Esophageal and Esophagogastric Junction Cancers focuses on recommendations for the management of locally advanced and metastatic adenocarcinoma of the esophagus and EGJ.
Journal ArticleDOI
Neoadjuvant Chemoradiotherapy Followed by Surgery Versus Surgery Alone for Locally Advanced Squamous Cell Carcinoma of the Esophagus (NEOCRTEC5010): A Phase III Multicenter, Randomized, Open-Label Clinical Trial.
Hong Yang,Hui Liu,Yuping Chen,Chengchu Zhu,Wentao Fang,Zhentao Yu,Weimin Mao,Jiaqing Xiang,Yongtao Han,Zhijian Chen,Haihua Yang,Jiaming Wang,Qingsong Pang,Xiao Zheng,Huanjun Yang,Tao Li,Florian Lordick,Xavier B. D’Journo,Robert J. Cerfolio,Robert J. Korst,Nuria M. Novoa,Scott J. Swanson,Alessandro Brunelli,Mahmoud Ismail,Hiran C. Fernando,Xu Zhang,Qun Li,Geng Wang,Baofu Chen,Teng Mao,Min Kong,Xufeng Guo,Ting Lin,Mengzhong Liu,Jianhua Fu +34 more
TL;DR: This trial shows that NCRT plus surgery improves survival over surgery alone among patients with locally advanced ESCC, with acceptable and manageable adverse events.
Journal ArticleDOI
Esophageal and esophagogastric junction cancers, version 1.2015.
Jaffer A. Ajani,Thomas A. D'Amico,Khaldoun Almhanna,David J. Bentrem,Stephen Besh,Joseph Chao,Prajnan Das,Crystal S. Denlinger,Paul T. Fanta,Charles S. Fuchs,Hans Gerdes,Robert E. Glasgow,James A. Hayman,Steven N. Hochwald,Wayne L. Hofstetter,David H. Ilson,Dawn E. Jaroszewski,Kory Jasperson,Rajesh N. Keswani,Lawrence Kleinberg,W. Michael Korn,Stephen Leong,A. Craig Lockhart,Mary F. Mulcahy,Mark B. Orringer,James Posey,George A. Poultsides,Aaron R. Sasson,Walter J. Scott,Vivian E. Strong,Thomas K. Varghese,Mary Kay Washington,Christopher G. Willett,Cameron D. Wright,Debra Zelman,Nicole R. McMillian,Hema Sundar +36 more
TL;DR: This portion of the NCCN Guidelines for Esophageal and EGJ Cancers discusses management of locally advanced adenocarcinoma of the esophagus andEGJ.
Journal ArticleDOI
Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 1.
Yuko Kitagawa,Takashi Uno,Tsuneo Oyama,Ken Kato,Hiroyuki Kato,Hirofumi Kawakubo,Osamu Kawamura,Motoyasu Kusano,Hiroyuki Kuwano,Hiroya Takeuchi,Yasushi Toh,Yuichiro Doki,Yoshio Naomoto,Kenji Nemoto,Eisuke Booka,Hisahiro Matsubara,Tatsuya Miyazaki,Manabu Muto,Akio Yanagisawa,Masahiro Yoshida +19 more
TL;DR: These guidelines are intended to allow physicians to undertake diagnosis and treatment of esophageal cancer by sharing the information contained in the guidelines and promote mutual understanding among the healthcare professionals, patients, and their family members.
Journal ArticleDOI
Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS ® ) Society Recommendations.
Donald E. Low,William H. Allum,Giovanni de Manzoni,Lorenzo E. Ferri,Arul Immanuel,Madhan Kumar Kuppusamy,Simon Law,Mats Lindblad,Nick Maynard,Joseph M. Neal,C S Pramesh,Michael J. Scott,B. Mark Smithers,Valérie Addor,Olle Ljungqvist +14 more
TL;DR: The current ERAS society guidelines should be reviewed and applied in all centers looking to improve outcomes and quality associated with esophageal resection.
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