Results of the FFCD 9901 Trial in Early-Stage Esophageal Carcinoma : Is It Really About Neoadjuvant Therapy ?
Mené sur 195 patients atteints d'un cancer de l'œsophage de stade I ou II traité par chirurgie entre 2000 et 2009 (durée médiane de suivi : 93,6 mois), cet essai de phase III évalue, du point de vue de la survie globale, du taux de résection R0 et de la mortalité postopératoire, l'intérêt d'un traitement néoadjuvant combinant de façon concomitante une radiothérapie et une chimiothérapie par cisplatine et fluorouracile
For decades, surgery has been the therapeutic cornerstone for patients with localized esophageal cancer. Unfortunately, outcomes after resection are poor, with most patients developing recurrence with its associated morbidity and mortality. Contemporary randomized trials have shown that locoregional failure occurs in up to 32% to 45% of patients. The caveat to these failure rates is that, frequently, only the first site of failure is recorded in the setting of an R0 resection ; this leads to potential underreporting of the true incidence. Regardless, these failure rates are unacceptably high and represent a major impediment to cure, prompting investigation of neoadjuvant chemoradiotherapy to improve outcomes. Over the last two decades, randomized trials have yielded conflicting results, with some studies supporting the use of chemoradiotherapy in patients with esophageal cancer and other trials showing no benefit. However, interpretation of results has been handicapped by shortcomings, including suboptimal radiation and/or chemotherapy administration and limited
accrual. Despite these limitations, meta-analyses have reported a modest survival benefit in patients receiving neoadjuvant chemoradiotherapy. More recently, Dutch investigators reported outcomes of the largest ever and most contemporary study evaluating the role of neoadjuvant chemoradiotherapy in patients with resectable esophageal cancer. Trial results demonstrated a doubling of median survival (49.4v 24months) with an absolute 5-year survival advantage of 13%with neoadjuvant treatment. Importantly, patterns of failure analyses in this trial strongly suggest that enhanced local control accounted for this survival benefit...
Journal of Clinical Oncology , éditorial en libre accès, 2014