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Research Letter |

Comparative Effectiveness of Preoperative Treatment Regimens in Patients With Potentially Resectable Esophageal Cancer ONLINE FIRST

Jennifer M. Duff, MD1; H. Charles Peters, MD2; William Zingarelli, MD2; Kfir Ben-David, MD3; George A. Sarosi, MD2; Ryan M. Thomas, MD2
[+] Author Affiliations
1Section of Hematology/Oncology, Department of Medicine, North Florida/South Georgia Veterans Health System and the University of Florida, Gainesville
2Department of Surgery, North Florida/South Georgia Veterans Health System and the University of Florida, Gainesville
3Department of Surgery, Mount Sinai Medical Center, Miami Beach, Florida
JAMA Surg. Published online September 14, 2016. doi:10.1001/jamasurg.2016.2821
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This study assesses the effectiveness of both preoperative chemoradiation with cisplatin and fluorouracil or carboplatin and paclitaxel on recurrence-free survival and overall survival in patients with esophageal cancer.

Despite potentially curative surgery, the 5-year survival rate for patients with esophageal cancer (EC) is approximately 25%, and thus, additional therapies have been explored to improve outcomes.1 Randomized trials have demonstrated improved recurrence-free survival (RFS) and overall survival (OS) in patients with EC treated with preoperative chemoradiation vs surgery alone.2,3 Historically, cisplatin-based regimens demonstrate higher tumor response rates but exhibit increased toxic effects compared with carboplatin-based regimens, which have become an attractive alternative.24 While preoperative chemoradiation with cisplatin and fluorouracil (cis/5FU) or carboplatin and paclitaxel (carbo/pac) have been studied individually in EC, comparative randomized trials are lacking. Given the cis/5FU and carbo/pac usage during 2 time periods (2005-2012 and 2011-present, respectively) at our institution, we hypothesized that despite concerns of toxic effects there would be no difference in treatment completion between cohorts, but preoperative cis/5FU would yield improved outcomes and should still be considered for patients with resectable EC.

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Figure.
Survival Analysis Comparing Patients Who Underwent Esophagectomy Based on Preoperative Chemoradiation Regimen

Kaplan-Meier product limit method estimation of (A) recurrence-free survival and (B) overall survival stratified by preoperative chemoradiation regimen of carboplatin and paclitaxel (Carbo/Pac) or cisplatin and fluoruracil (Cis/5FU) in patients who underwent potentially curative esophagectomy for esophageal malignancy.

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