Triple therapy prolongs life in esophageal cancer

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In a multicenter study of patients with early-stage cancer of the esophagus, those who were treated with radiation and chemotherapy before surgery lived more than twice as long as those who were treated with surgery alone, the current standard.

“I think the important message that we can take from this trial is that there is actually a curative possibility for patients with esophageal cancer and that hopefully chemotherapy and radiation therapy followed by surgery will make a difference,” Dr. Mark Krasna of the University of Maryland School of Medicine said at a press briefing Thursday.

In the study, 30 patients with stage I, II, or III esophageal cancer were randomized to standard chemotherapy plus radiation therapy followed 3 to 8 weeks later by surgery, while 26 patients were randomized to surgery alone. The median follow up was 6 years.

"The survival differences were stark,” said Krasna. Median survival in the triple treatment arm was 4.5 years compared with 1.8 years in the surgery-alone arm.

The 5-year survival rate also favored triple therapy over surgery alone (39 percent vs 16 percent). “Again, this is a stark difference—nearly triple the survival advantage,” Krasna said.

Esophageal cancer is becoming increasingly common and is generally difficult to treat. Although surgery alone has been the gold standard for treating this disease, the current study, Krasna said, suggests that “adding preoperative chemotherapy and radiation therapy may be significantly more effective in extending survival in this group of patients.”

He presented the findings Thursday during the 2006 Gastrointestinal Cancers Symposium, co-sponsored by the American Gastroenterological Association, the American Society of Clinical Oncology, the American Society for Therapeutic Radiology and Oncology, and the Society of Surgery Oncology. 

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