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Table 2 Esophageal Cancer. Neoadjuvant Therapy plus surgery vs. surgery versus definitivie Radiochemotherapy

From: First statement on preparation for the COVID-19 pandemic in large German Speaking University-based radiation oncology departments

Kranzfelder et al. Br J Surg 2011

Metaanlysis

Nine RCTs involving neoadjuvant CRT versus surgery, eight involving neoadjuvant chemotherapy versus surgery, and three involving neoadjuvant treatment followed by surgery or surgery alone versus dCRT

Neoad. RChT:

Sign. OS-Benefit (HR 0,81)

Neoadj. ChT:

No OS-Benefit (HR 0,93, p = 0,36)

No OS difference after dCRT demonstrated a significant survival benefit, but treatment-related mortality rates were lower (HR 7·60, P = 0·007) than with neoadjuvant treatment followed by surgery or surgery alone.

Stahl et al. JCO 2005

Phase III-Study (1994–2002, 189 Pat.)

CRT: 40 Gy + Cisplatin/Etoposid vs. def. RCHT

adding surgery to chemoradiotherapy improves local tumor control but does not increase survival of patients with locally advanced esophageal SCC. Tumor response to induction chemotherapy identifies a favorable prognostic group within these high-risk patients, regardless of the treatment group.

FFCD 9102

Bedenne et al. JCO 2007

Phase III-Study (1993–2000, 259 Pat.)

T3 N0–1, 89% SCC

Neoadj. CRT: Split course 30 Gy in 3 Gy or 45 Gy in 1,8 Gy + 2x Cisplatin/5-FU

Random.: OP vs. def. CRT

two-year survival rate was 34% in arm A versus 40% in arm B (hazard ratio for arm B v arm A = 0.90; adjusted P = .44). Median survival time was 17.7 months in arm A compared with 19.3 months in arm B

Author conclusion: there is no benefit for the addition of surgery after chemoradiation compared with the continuation of additional chemoradiation