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"We think that patients with esophageal cancer have the best chance to survive this cancer when they are treated with preoperative chemo-radiotherapy followed by surgery," said lead researcher Dr. Ate van der Gaast, from the medical oncology department at Erasmus University Hospital in Rotterdam. "By giving preoperative chemo-radiotherapy, more patients are cured than with surgery alone."
For the study, published in the May 31 issue of the New England Journal of Medicine, the Dutch team randomly assigned nearly 400 people with esophageal cancer either to surgery alone or chemotherapy and radiation before surgery.
The researchers found patients who received chemotherapy before surgery lived an average of four years, while those who went straight to surgery lived an average of two years. More patients in the chemotherapy group had a complete response to treatment and had more of the cancer removed during surgery than those who had surgery alone, the team also noted.
Complications after surgery were similar in both groups, and 4 percent of patients in each group died in the hospital after the procedure, the researchers added.
Dr. Raja Flores, chief of thoracic surgery at Mount Sinai Hospital in New York City, said "these findings were what everyone expected, but not to the degree it came out."
With esophageal cancer, removing the cancer from the area around the tumor is key to treatment. Chemotherapy and radiation is performed before surgery to help contain the cancer so more of it can be removed during the operation, Flores explained.
This approach is becoming standard therapy, he said, "but this study gives the proof positive that that's the way it should go."
Flores said although the treatment adds initial cost, it can save money. "If it leads to more cures, it's going to save money," he said.
Patients need to make sure this approach is discussed with them "so they just don't run straight to surgery," Flores said.
Dr. Harvey Mamon is clinical director of the department of radiation oncology at Brigham and Women's Hospital and Dana Farber Cancer Institute in Boston. He said: "This is an important and well-done study that will influence practice patterns. For all intents and purposes, the standard of care for locally advanced esophageal cancer was already preoperative chemo-radiation followed by surgery."
The significant improvement in the chemo-radiation portion in this trial confirms this current standard of care, he said. "I don't think we're likely to see further trials of surgery alone versus surgery following chemo-radiation."
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