Li, A.G.K.; Fernandes, E.; Wong, J.K.F.; Choke, E.; Nicolson, M.; Park, K.G.M.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA83
Academic Journal
Background: Surgical resection of carcinoma of oesophagus or stomach provides the best means of disease control when a complete resection is possible. Moreover, the majority of patients present at a late stage, and a surgical approach is not often possibe. While patients with operable oesophageal and gastric cancers may benefit from neo-adjuvant chemotherapy followed by surgery, it is not clear whether patients who present with inoperable disease that is downstaged with chemotherapy benefit from subsequent surgery. Aim: To determinate the benefit of surgery after downstaging with chemotherapy in locally advanced OG cancer. Methods: Between 1994 and 1998, a single institution, non randomised study, evaluated the outcome of patients who underwent surgery after chemotherapy downstaging, compared to the control group without subsequent surgery. 26 patients with inoperable, locally advanced oesophagogastric tumours were treated with a standard regimen of either pirubicin, cisplatin and infusional 5 flurouracile (ECF), or mitomycin, cisplatin and infusional 5 flurouracile (MCF). After completion of chemotherapy (3-8 cycles) 13/26 patients were down staged sufficiently to allow a surgical resection to be undertaken. Patients were followed up until death or for a minimum of 45 months. Results: The overall mean survival in the patients who underwent a resection was 33.1 months (8.1-81.8 months), whereas in the non-resected patients the mean of survival was 13.2 months (3.5-55 months). In the resected group 9 died of disseminated malignancy and and 4 remain disease free 41.3-66.6 months following surgery. Of the 13 non-resected patients 1 remains alive after 55 months. The remainder have died of progressive local (n = 5) or disseminated disease (n = 6). Conclusion: In a subgroup of patients with locally advanced oesophagogastric cancers, surgical resection following down staging with combination chemotherapy can provide long term survival. It is likely that this is due...


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