Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer.
Authors
Cunningham, DavidAllum, 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
Affiliation
Department of Medicine, Royal Marsden Hospital, Sutton , Surrey, United Kingdom. david.cunningham@rmh.nhs.ukIssue Date
2006-07-06
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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 MedicineDOI
10.1056/NEJMoa055531PubMed ID
16822992Type
ArticleLanguage
enISSN
1533-4406ae974a485f413a2113503eed53cd6c53
10.1056/NEJMoa055531
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