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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].).
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
html.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].).


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