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Archived Comments for: High-dose chemoradiotherapy followed by surgery versus surgery alone in esophageal cancer: a retrospective cohort study

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  1. Chemoradiotherapy followed by surgery versus surgery alone in esophageal cancer patients: is a time of additional randomized trials?

    stefano cafarotti, Department of Thoracic Surgery - Catholic University -Rome - Italy

    17 January 2011

    Stefano Cafarotti, Alfredo Cesario, Venanzio Porziella, Stefano Margaritora and Pierluigi Granone

    We compliment Meysan Hurmuzlu and colleagues (1) for their report on outcome of high-dose preoperative chemoradiotherapy (CRT) in operable locally advanced esophageal cancer patients compared to surgery alone, which we have read with great interest.
    It is well known that the Patients with esophageal cancer continue to have a poor prognosis with a 5 year survival rate less than 20% due to the advanced stage at the time of presentation. However, there is no universally appropriate treatment and management depends
    upon the patient's general condition and resectability criteria. The role of neoadjuvant chemoradiotherapy in technically operable IIa-III esophageal carcinoma is still unresolved. In a phase III trial comparing trimodality therapy with cisplatin, Fluorouracil, Radiotherapy, and Surgery with surgery alone Tepper and associates supported trimodality therapy as a standard of care for patients with this disease (2). In a phase II trial of preoperative CRT followed by surgery Knox and associates reported encouraging survival in trimodality group respect to the surgery alone group (3). . Several randomized studies have also failed to show a survival advantage following neoadjuvant CRT (4) as reported by the Authors themselves. We agree with the Authors that the study was retrospective and with limited number of patients but we consider this in light to demonstrated that future additional randomized trials is necessary. Moreover, they showed no significant survival advantage in esophageal cancer stage IIA-III treated with preoperative high-dose CRT compared to surgery alone in the context of a "positive" underpowered results of recent published trials as demonstrated by Pereira (5). Convincing arguments for changing clinical practice will need to be strong.

    1. Hurmuzlu M, Øvrebø K, Monge OR, Smaaland R, Wentzel-Larsen T, Viste A. High-dose chemoradiotherapy followed by surgery versus surgery alone in esophageal cancer: a retrospective cohort study. World J Surg Oncol. 2010 Jun 1;8:46.

    2. Tepper J, Krasna MJ, Niedzwiecki D, Hollis D, Reed CE, Goldberg R, Kiel K, Willett C, Sugarbaker D, Mayer R. Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol. 2008 Mar 1;26(7):1086-92.

    3. Knox JJ, Wong R, Visbal AL, Horgan AM, Guindi M, Hornby J, Xu W, Ringash J, Keshavjee S, Chen E, Haider M, Darling G. Phase 2 trial of preoperative irinotecan plus cisplatin and conformal radiotherapy, followed by surgery for esophageal cancer. Cancer. 2010 Sep 1;116(17):4023-32.
    4. Burmeister BH, Smithers BM, Gebski V, Fitzgerald L, Simes RJ, Devitt P, Ackland S, Gotley DC, Joseph D, Millar J, North J, Walpole ET, Denham JW, Trans-Tasman Radiation Oncology Group; Australasian Gastro-Intestinal Trials Group: Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial. Lancet Oncol 2005, 6:659-668
    5. Pereira B, Gourgou-Bourgade S, Azria D, Ychou M. Neoadjuvant chemoradiotherapy in esophageal cancer: is it still the question? J Clin Oncol. 2008 Nov 1;26(31):5133-4; author reply 5134.

    Competing interests