Combination Chemoradiation Therapy: The Whole Is More Than the Sum of the Parts
Menée sur 418 patients atteints d'un cancer de l'œsophage ou de la jonction gastro-œsophagienne (durée médiane de suivi : 45 mois), cette étude identifie les types histologiques associés à la maladie ainsi que les formes de récidive après une chimioradiothérapie pré-opératoire à base de paclitaxel-carboplatine, puis évalue l'intérêt de ce traitement pour réduire le risque de récidive ou de carcinomatose péritonéale
For many years, oncologists have held the view that “radiation improves local control, but not survival.” Although this perspective is fairly common, it is not always accurate and does not recognize a more nuanced interplay between local control, systemic control, and cure. Solid tumors cannot be cured without achieving local control of the primary malignancy, and thus local control is a critical component of tumor cure. A more nuanced statement that could be true might be the following: “When surgery provides good local control, the local
control advantage provided by radiation may not lead to a statistically significant survival advantage if the competing risk of distant metastases is very high or very low.” Radiation therapy also might not improve survival if systemic chemotherapy improved local control without radiation, or if salvage surgery were effective and local recurrence did not increase the risk of distant metastases. It is worth considering the relationship between local control and survival in several solid tumors...
Journal of Clinical Oncology , éditorial en libre accès, 2014