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Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer

Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer
Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer
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.
11-20
Cunningham, David
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Allum, William H.
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Stenning, Sally P.
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Thompson, Jeremy N.
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Van de Velde, Cornelis J.H.
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Nicolson, Marianne
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Scarffe, J. Howard
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Lofts, Fiona J.
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Falk, Stephen J.
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Iveson, Timothy J.
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Smith, David B.
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Langley, Ruth E.
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Verma, Monica
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Weeden, Simon
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Chua, Yu Jo, for the MAGIC Trial Participants
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Cunningham, David
c40c8fe4-7eac-4b98-aaa5-b866da1e32ab
Allum, William H.
19a9b8a7-e082-4450-9703-ca80b5456087
Stenning, Sally P.
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Thompson, Jeremy N.
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Van de Velde, Cornelis J.H.
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Nicolson, Marianne
ed578571-b31b-4046-a15e-ce4c56f424e1
Scarffe, J. Howard
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Lofts, Fiona J.
87aec526-3314-477d-97f5-67e0322f36f3
Falk, Stephen J.
ba3ba3cc-afa7-401b-b432-2a67010bc03b
Iveson, Timothy J.
867cb6c5-ea9a-4521-a4cc-4cd4d2503b3a
Smith, David B.
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Langley, Ruth E.
bf82e2b5-a6bf-4d8a-8ac4-cb5596fc3114
Verma, Monica
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Weeden, Simon
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Chua, Yu Jo, for the MAGIC Trial Participants
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Cunningham, David, Allum, William H., Stenning, Sally P., Thompson, Jeremy N., Van de Velde, Cornelis J.H., Nicolson, Marianne, Scarffe, J. Howard, Lofts, Fiona J., Falk, Stephen J., Iveson, Timothy J., Smith, David B., Langley, Ruth E., Verma, Monica, Weeden, Simon and Chua, Yu Jo, for the MAGIC Trial Participants (2006) Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. New England Journal of Medicine, 355 (1), 11-20. (doi:10.1056/NEJMoa055531).

Record type: Article

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.

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Published date: 6 July 2006

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Local EPrints ID: 44625
URI: http://eprints.soton.ac.uk/id/eprint/44625
PURE UUID: 3e4c2a13-0ea2-440a-8be3-0b46f2c6d3e9

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Date deposited: 02 Mar 2007
Last modified: 16 Dec 2019 19:19

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Contributors

Author: David Cunningham
Author: William H. Allum
Author: Sally P. Stenning
Author: Jeremy N. Thompson
Author: Cornelis J.H. Van de Velde
Author: Marianne Nicolson
Author: J. Howard Scarffe
Author: Fiona J. Lofts
Author: Stephen J. Falk
Author: Timothy J. Iveson
Author: David B. Smith
Author: Ruth E. Langley
Author: Monica Verma
Author: Simon Weeden
Author: Yu Jo, for the MAGIC Trial Participants Chua

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