Neoadjuvant Chemoradiotherapy Versus Chemotherapy for the Treatment of Locally Advanced Esophageal Adenocarcinoma in the European Multicenter ENSURE Study.
Details
Serval ID
serval:BIB_FD25BABA1D79
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Neoadjuvant Chemoradiotherapy Versus Chemotherapy for the Treatment of Locally Advanced Esophageal Adenocarcinoma in the European Multicenter ENSURE Study.
Journal
Annals of surgery
Working group(s)
ENSURE Study Group
Contributor(s)
Van Veer H., Depypere L., Coosemans W., Nafteux P., Carroll P., Allison F., Darling G., Findlay J.M., Everden S., Maynard N.D., Ariyarathenam A., Sanders G., Jaunoo S., Singh P., Parsons S., Saunders J., Vohra R., Sinha A., Tan B.H., Whiting J.G., Boshier P.R., Phillips A.W., Griffin S.M., Walker R.C., Underwood T.J., Piessen G., Theisen J., Friess H., Bruns C.J., Schröder W., Collins C.G., McAnena O.J., Rooney S., Quinn A., Toale C., Murphy T.J., Ravi N., Donohoe C.L., Scarpa M., Bardini R., Degasperi S., Saadeh L., Castoro C., Alfieri R., Pinto E., Mattara G., Kalff M.C., Gisbertz S.S., Berge Henegouwen MIV, van Hootegem S.J., Lagarde S.M., Lanschot JJBV, Kingma B.F., Rurrda J.P., van Hillegersberg R., Kennedy R., Carey P.D., Prodehl L., Lamb P.J., Skipworth R.J., Cero M.D., Pera M., Huang B., Linder G., Sundbom M., Mantziari S., Schäfer M., Demartines N.
ISSN
1528-1140 (Electronic)
ISSN-L
0003-4932
Publication state
Published
Issued date
01/11/2023
Peer-reviewed
Oui
Editor
Van Veer H Depypere L. Coosemans W. Nafteux P. Carroll P. Allison F. Darling G. Findlay J. M. Everden S. Maynard N. D. Ariyarathenam A. Sanders G. Jaunoo S. Singh P. Parsons S. Saunders J. Vohra R. Sinha A. Tan B. H. Whiting J. G. Boshier P. R. Phillips A. W. Griffin S. M. Walker R. C. Underwood T. J. Piessen G. Theisen J. Friess H. Bruns C. J. Schroder W. Collins C. G. McAnena O. J. Rooney S. Quinn A. Toale C. Murphy T. J. Ravi N. Donohoe C. L. Scarpa M. Bardini R. Degasperi S. Saadeh L. Castoro C. Alfieri R. Pinto E. Mattara G. Kalff M. C. Gisbertz S. S. Berge Henegouwen M. I. V. van Hootegem S. J. Lagarde S. M. Lanschot Jjbv Kingma B. F. Rurrda J. P. van Hillegersberg R. Kennedy R. Carey P. D. Prodehl L. Lamb P. J. Skipworth R. J. Cero M. D. Pera M. Huang B. Linder G. Sundbom M. Mantziari S. Schafer M. Demartines N.
Volume
278
Number
5
Pages
692-700
Language
english
Notes
Publication types: Clinical Trial ; Journal Article ; Multicenter Study
Publication Status: ppublish
Publication Status: ppublish
Abstract
This study aimed to compare clinicopathologic, oncologic, and health-related quality of life (HRQL) outcomes following neoadjuvant chemoradiation (nCRT) and chemotherapy (nCT) in the ENSURE international multicenter study.
nCT and nCRT are the standards of care for locally advanced esophageal cancer (LAEC) treated with curative intent. However, no published randomized controlled trial to date has demonstrated the superiority of either approach.
ENSURE is an international multicenter study of consecutive patients undergoing surgery for LAEC (2009-2015) across 20 high-volume centers (NCT03461341). The primary outcome measure was overall survival (OS), secondary outcomes included histopathologic response, recurrence pattern, oncologic outcome, and HRQL in survivorship.
A total of 2211 patients were studied (48% nCT, 52% nCRT). pCR was observed in 4.9% and 14.7% ( P <0.001), with R0 in 78.2% and 94.2% ( P <0.001) post nCT and nCRT, respectively. Postoperative morbidity was equivalent, but in-hospital mortality was independently increased [hazard ratio (HR)=2.73, 95% CI: 1.43-5.21, P= 0.002] following nCRT versus nCT. Probability of local recurrence was reduced (odds ratio=0.71, 95% CI: 0.54-0.93, P =0.012), and distant recurrence-free survival time reduced (HR=1.18, 95% CI: 1.02-1.37, P =0.023) after nCRT versus nCT, with no difference in OS among all patients (HR=1.10, 95% CI: 0.98-1.25, P =0.113). On subgroup analysis, patients who underwent R0 resection following nCT as compared with nCRT had improved OS (median: 60.7 months, 95% CI: 49.5-71.8 vs 40.8 months, 95% CI: 42.8-53.4, P <0.001).
In this European multicenter study, nCRT compared with nCT was associated with reduced probability of local recurrence but reduced distant recurrence-free survival for patients with LAEC, without differences in OS. These data support tailored patient-specific decision-making in the overall approach to achieving optimum outcomes in LAEC.
nCT and nCRT are the standards of care for locally advanced esophageal cancer (LAEC) treated with curative intent. However, no published randomized controlled trial to date has demonstrated the superiority of either approach.
ENSURE is an international multicenter study of consecutive patients undergoing surgery for LAEC (2009-2015) across 20 high-volume centers (NCT03461341). The primary outcome measure was overall survival (OS), secondary outcomes included histopathologic response, recurrence pattern, oncologic outcome, and HRQL in survivorship.
A total of 2211 patients were studied (48% nCT, 52% nCRT). pCR was observed in 4.9% and 14.7% ( P <0.001), with R0 in 78.2% and 94.2% ( P <0.001) post nCT and nCRT, respectively. Postoperative morbidity was equivalent, but in-hospital mortality was independently increased [hazard ratio (HR)=2.73, 95% CI: 1.43-5.21, P= 0.002] following nCRT versus nCT. Probability of local recurrence was reduced (odds ratio=0.71, 95% CI: 0.54-0.93, P =0.012), and distant recurrence-free survival time reduced (HR=1.18, 95% CI: 1.02-1.37, P =0.023) after nCRT versus nCT, with no difference in OS among all patients (HR=1.10, 95% CI: 0.98-1.25, P =0.113). On subgroup analysis, patients who underwent R0 resection following nCT as compared with nCRT had improved OS (median: 60.7 months, 95% CI: 49.5-71.8 vs 40.8 months, 95% CI: 42.8-53.4, P <0.001).
In this European multicenter study, nCRT compared with nCT was associated with reduced probability of local recurrence but reduced distant recurrence-free survival for patients with LAEC, without differences in OS. These data support tailored patient-specific decision-making in the overall approach to achieving optimum outcomes in LAEC.
Keywords
Humans, Adenocarcinoma/pathology, Chemoradiotherapy, Esophageal Neoplasms/pathology, Neoadjuvant Therapy, Neoplasm Staging, Quality of Life
Pubmed
Web of science
Create date
24/07/2023 14:36
Last modification date
21/11/2023 8:10
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