Surgery News - October 2007 - (Page 22)

22 ONCOLOGY SURGERY NEWS • O C T O B E R 2 0 0 7 Preop Chemo Stretches Gastroesophageal Ca Survival BY BRUCE K. DIXON Else vier Global Medical Ne ws C H I C A G O — Preoperative treatment with 5-fluorouracil and cisplatin may be superior to surgery alone in extending survival in patients with resectable adenocarcinoma of the lower esophagus, esophagogastric junction, or stomach, according to phase III trial results presented at the annual meeting of the American Society of Clinical Oncology. At a median follow-up of 5.7 years, the preoperative chemotherapy arm had an overall survival rate of 38% versus 24% in the surgery-only arm. Median diseasefree survival rates were 34% and 21%, respectively. This confirms a previous study and suggests that preop chemotherapy can increase patient survival to 5 years and may increase disease-free survival, said Dr. Valerie Boige, lead author of the trial, coordinated by the Fédérale Nationale des Centres de Lutte Contre Le Cancer (FNLCC) in Paris. The phase III MAGIC trial from the United Kingdom found a perioperative regimen of epirubicin, cisplatin, and 5-fluorouacil, given before and after surgery, also reduced the death risk compared with surgery alone (N. Engl. J. Med. 2006;355:11-20). In MAGIC, 75% of patients had gastric cancers; 75% of patients in the current study had esophageal or gastroesophageal junction tumors. Although the French trial was designed to test the benefit of preoperative chemotherapy, about half of the patients— primarily those whose disease responded Membership in the American College of Surgeons? H E R E ’ S W H Y I T ’ S I M P O R TA N T: AS A BODY REPRESENTING ALL OF SURGERY, THE COLLEGE: • Provides a cohesive voice addressing societal issues related to surgery. • Is working toward having an increasingly proactive and timely voice in setting a national tone and agenda with regard to health care. • Is dedicated to promoting the highest standards of surgical care through education of and advocacy for its Fellows and their patients. • Serves as a national forum through which surgeons can reinforce the values and ethics that traditionally have characterized the surgical profession. HERE ARE SOME OF THE MANY BENEFITS BEING A MEMBER OF THE COLLEGE AFFORDS YOU: • Free registration at the Clinical Congress • Access to the College’s free coding consultation hotline • Subscription to ACS NewsScope, the College’s weekly electronic newsletter • Subscription to the Bulletin of the American College of Surgeons • Subscription to the Journal of the American College of Surgeons • Access to all College-sponsored insurance, credit card, and other helpful programs • Free posting of resume on ACS Career Opportunities • Access to Surgeons Diversiﬁed Investment Fund THERE IS STRENGTH IN NUMBERS. Our members represent every specialty, practice setting, and stage of practice. Their views and concerns are helping to shape the College’s agenda for the future. If you aren’t a member of the American College of Surgeons, apply for Fellowship today. If you are already a member, maintain that status and consider getting involved in the work of the College. Only by banding together and using our collective strength can we bring about positive change for our patients and ourselves—and for surgeons of the future. Information on becoming a member of the College and an application form are available online at w w w.f ac s .org/dept /fellowship/index .html or contact Cynthia Hicks, Credentials Section, Division of Member Services, via phone at 1-800/293-9623, or via e-mail at chicks@facs.org. to, or remained stable with, well-tolerated preoperative chemotherapy—also received up to four additional cycles of the same regimen after surgery. One observer noted that, as with the MAGIC trial, this design makes it hard to know exactly how much each part of the perioperative approach is contributing to the results. Between 1995 and 2003, 113 of 224 patients with stage II or higher adenocarcinoma were randomized to receive preoperative chemotherapy followed by surgery 4-6 weeks later. The remaining patients underwent surgery immediately, said Dr. Boige of the Institut Gustave Roussy in Villejuif. After surgery about half of the preop chemotherapy group also received up to four additional cycles of the same regimen. Surgery only patients had no postop treatment. Grade 3-4 toxicities with preop chemotherapy included neutropenia (20%) and nausea and vomiting (9%). One patient died from toxicity a month after the first cycle; 37% of patients had severe Preoperative toxicity. Postop chemotherapy showed an overall morbidity and mortality did not differ survival rate of 38% vs. 24% with significantly. Microscopic resurgery only. sections were comDR. BOIGE plete in 75% of the surgery group and in 87% of the chemotherapy group, a statistically significant difference. At baseline, there were no statistically significant differences in age (median 61 years), gender (83% men), or performance status (75% WHO of 0). “In resectable gastroesophageal adenocarcinoma, preoperative chemotherapy with 5-FU and cisplatin significantly increases the curative resection rate and significantly improves overall survival without increasing postoperative morbidity and mortality,” Dr. Boige concluded. In his discussion of the paper, Dr. David H. Ilson of Memorial Sloan-Kettering Cancer Center in New York City agreed that, as with other trials of adenocarcinomas, there does appear to be a survival benefit for preoperative chemotherapy with cisplatin and 5-FU. Dr. Ilson added that this trial demonstrated a 13% improvement in the rate of R-zero resection with chemotherapy, though the impact on tumor downstaging was not statistically significant. The major impact was to reduce systemic recurrence to 42% from 56% for surgery alone, but local recurrence was not affected. “And while cisplatin-fluorouracil in this trial were similar to the epirubicin regimen in the MAGIC trial, one could argue that in esophagus and GE junction cancers perhaps epirubicin is not required,” he said, adding that some aspects concerned him. “The relative small sample size means that differences of 10 to 15 percentage points come down to outcome differences in only 10 to 15 patients. Also, endoscopic ultrasound was not performed, so we question the accuracy of pretherapy staging.” ■ http://www.facs.org/dept/fellowship/index.html http://www.facs.org/dept/fellowship/index.html

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