Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer.

2.50
Hdl Handle:
http://hdl.handle.net/10541/72532
Title:
Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer.
Authors:
Cunningham, David; Allum, William H; Stenning, Sally P; Thompson, Jeremy N; Van de Velde, Cornelius; Nicolson, Marianne; Scarffe, J Howard; Lofts, Fiona J; Falk, Stephen J; Iveson, T; Smith, David B; Langley, Ruth E; Verma, Monica; Weeden, Simon; Chua, Y J; MAGIC Trial Participants
Abstract:
BACKGROUND: A regimen of epirubicin, cisplatin, and infused fluorouracil (ECF) improves survival among patients with incurable locally advanced or metastatic gastric adenocarcinoma. We assessed whether the addition of a perioperative regimen of ECF to surgery improves outcomes among patients with potentially curable gastric cancer. METHODS: We randomly assigned patients with resectable adenocarcinoma of the stomach, esophagogastric junction, or lower esophagus to either perioperative chemotherapy and surgery (250 patients) or surgery alone (253 patients). Chemotherapy consisted of three preoperative and three postoperative cycles of intravenous epirubicin (50 mg per square meter of body-surface area) and cisplatin (60 mg per square meter) on day 1, and a continuous intravenous infusion of fluorouracil (200 mg per square meter per day) for 21 days. The primary end point was overall survival. RESULTS: ECF-related adverse effects were similar to those previously reported among patients with advanced gastric cancer. Rates of postoperative complications were similar in the perioperative-chemotherapy group and the surgery group (46 percent and 45 percent, respectively), as were the numbers of deaths within 30 days after surgery. The resected tumors were significantly smaller and less advanced in the perioperative-chemotherapy group. With a median follow-up of four years, 149 patients in the perioperative-chemotherapy group and 170 in the surgery group had died. As compared with the surgery group, the perioperative-chemotherapy group had a higher likelihood of overall survival (hazard ratio for death, 0.75; 95 percent confidence interval, 0.60 to 0.93; P=0.009; five-year survival rate, 36 percent vs. 23 percent) and of progression-free survival (hazard ratio for progression, 0.66; 95 percent confidence interval, 0.53 to 0.81; P<0.001). CONCLUSIONS: In patients with operable gastric or lower esophageal adenocarcinomas, a perioperative regimen of ECF decreased tumor size and stage and significantly improved progression-free and overall survival. (Current Controlled Trials number, ISRCTN93793971 [controlled-trials.com].).
Affiliation:
Department of Medicine, Royal Marsden Hospital, Sutton , Surrey, United Kingdom. david.cunningham@rmh.nhs.uk
Citation:
Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. 2006, 355 (1):11-20 N. Engl. J. Med.
Journal:
The New England Journal of Medicine
Issue Date:
6-Jul-2006
URI:
http://hdl.handle.net/10541/72532
DOI:
10.1056/NEJMoa055531
PubMed ID:
16822992
Type:
Article
Language:
en
ISSN:
1533-4406
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorCunningham, David-
dc.contributor.authorAllum, William H-
dc.contributor.authorStenning, Sally P-
dc.contributor.authorThompson, Jeremy N-
dc.contributor.authorVan de Velde, Cornelius-
dc.contributor.authorNicolson, Marianne-
dc.contributor.authorScarffe, J Howard-
dc.contributor.authorLofts, Fiona J-
dc.contributor.authorFalk, Stephen J-
dc.contributor.authorIveson, T-
dc.contributor.authorSmith, David B-
dc.contributor.authorLangley, Ruth E-
dc.contributor.authorVerma, Monica-
dc.contributor.authorWeeden, Simon-
dc.contributor.authorChua, Y J-
dc.contributor.authorMAGIC Trial Participants-
dc.date.accessioned2009-07-06T10:17:52Z-
dc.date.available2009-07-06T10:17:52Z-
dc.date.issued2006-07-06-
dc.identifier.citationPerioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. 2006, 355 (1):11-20 N. Engl. J. Med.en
dc.identifier.issn1533-4406-
dc.identifier.pmid16822992-
dc.identifier.doi10.1056/NEJMoa055531-
dc.identifier.urihttp://hdl.handle.net/10541/72532-
dc.description.abstractBACKGROUND: A regimen of epirubicin, cisplatin, and infused fluorouracil (ECF) improves survival among patients with incurable locally advanced or metastatic gastric adenocarcinoma. We assessed whether the addition of a perioperative regimen of ECF to surgery improves outcomes among patients with potentially curable gastric cancer. METHODS: We randomly assigned patients with resectable adenocarcinoma of the stomach, esophagogastric junction, or lower esophagus to either perioperative chemotherapy and surgery (250 patients) or surgery alone (253 patients). Chemotherapy consisted of three preoperative and three postoperative cycles of intravenous epirubicin (50 mg per square meter of body-surface area) and cisplatin (60 mg per square meter) on day 1, and a continuous intravenous infusion of fluorouracil (200 mg per square meter per day) for 21 days. The primary end point was overall survival. RESULTS: ECF-related adverse effects were similar to those previously reported among patients with advanced gastric cancer. Rates of postoperative complications were similar in the perioperative-chemotherapy group and the surgery group (46 percent and 45 percent, respectively), as were the numbers of deaths within 30 days after surgery. The resected tumors were significantly smaller and less advanced in the perioperative-chemotherapy group. With a median follow-up of four years, 149 patients in the perioperative-chemotherapy group and 170 in the surgery group had died. As compared with the surgery group, the perioperative-chemotherapy group had a higher likelihood of overall survival (hazard ratio for death, 0.75; 95 percent confidence interval, 0.60 to 0.93; P=0.009; five-year survival rate, 36 percent vs. 23 percent) and of progression-free survival (hazard ratio for progression, 0.66; 95 percent confidence interval, 0.53 to 0.81; P<0.001). CONCLUSIONS: In patients with operable gastric or lower esophageal adenocarcinomas, a perioperative regimen of ECF decreased tumor size and stage and significantly improved progression-free and overall survival. (Current Controlled Trials number, ISRCTN93793971 [controlled-trials.com].).en
dc.language.isoenen
dc.subjectOesophageal Canceren
dc.subjectOesophagectomyen
dc.subjectOesophagogastric Junctionen
dc.subjectStomach Canceren
dc.subject.meshAdenocarcinoma-
dc.subject.meshAdult-
dc.subject.meshAged-
dc.subject.meshAged, 80 and over-
dc.subject.meshAntineoplastic Combined Chemotherapy Protocols-
dc.subject.meshChemotherapy, Adjuvant-
dc.subject.meshCisplatin-
dc.subject.meshDisease-Free Survival-
dc.subject.meshEpirubicin-
dc.subject.meshEsophageal Neoplasms-
dc.subject.meshEsophagectomy-
dc.subject.meshEsophagogastric Junction-
dc.subject.meshFemale-
dc.subject.meshFluorouracil-
dc.subject.meshGastrectomy-
dc.subject.meshHumans-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshPerioperative Care-
dc.subject.meshStomach Neoplasms-
dc.subject.meshSurvival Rate-
dc.titlePerioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer.en
dc.typeArticleen
dc.contributor.departmentDepartment of Medicine, Royal Marsden Hospital, Sutton , Surrey, United Kingdom. david.cunningham@rmh.nhs.uken
dc.identifier.journalThe New England Journal of Medicineen

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