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    Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer.

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    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
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    Affiliation
    Department of Medicine, Royal Marsden Hospital, Sutton , Surrey, United Kingdom. david.cunningham@rmh.nhs.uk
    Issue Date
    2006-07-06
    
    Metadata
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    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].).
    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
    URI
    http://hdl.handle.net/10541/72532
    DOI
    10.1056/NEJMoa055531
    PubMed ID
    16822992
    Type
    Article
    Language
    en
    ISSN
    1533-4406
    ae974a485f413a2113503eed53cd6c53
    10.1056/NEJMoa055531
    Scopus Count
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