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 Journal Article


Authors: Kelsen, D. P.; Winter, K. A.; Gunderson, L. L.; Mortimer, J.; Estes, N. C.; Haller, D. G.; Ajani, J. A.; Kocha, W.; Minsky, B. D.; Roth, J. A.; Willett, C. G.
Article Title: 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
Abstract: 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. © 2007 by American Society of Clinical Oncology.
Keywords: cancer chemotherapy; cancer survival; controlled study; treatment response; aged; disease-free survival; middle aged; cancer surgery; survival rate; major clinical study; overall survival; carcinoma, squamous cell; cisplatin; fluorouracil; cancer radiotherapy; comparative study; disease free survival; postoperative care; preoperative care; neoadjuvant therapy; outcome assessment; adenocarcinoma; antineoplastic combined chemotherapy protocols; relapse; tumor regression; long term care; esophagus cancer; health care organization; esophageal neoplasms; esophagectomy
Journal Title: Journal of Clinical Oncology
Volume: 25
Issue: 24
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2007-08-20
Start Page: 3719
End Page: 3725
Language: English
DOI: 10.1200/jco.2006.10.4760
PUBMED: 17704421
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 73" - "Export Date: 17 November 2011" - "CODEN: JCOND" - "Source: Scopus"
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MSK Authors
  1. Bruce Minsky
    264 Minsky
  2. David P Kelsen
    341 Kelsen