Safety of Neoadjuvant Chemoradiotherapy Followed by Surgery for Patients With Locally Advanced Esophageal Squamous Cell Carcinoma
Mené entre 2017 et 2018 sur 264 patients atteints d'un carcinome épidermoïde de l'oesophage localement avancé (âge moyen : 61,4 ans ; 86 % d'hommes), cet essai randomisé multicentrique évalue l'efficacité, du point de vue de la survie globale à 3 ans, et la sécurité d'un traitement comportant une chimioradiothérapie néoadjuvante (placlitaxel + 40 Gy) suivie d'une oesophagectomie mini-invasive par rapport à un traitement comportant une chimiothérapie néoadjuvante (paclitaxel) suivie d'une oesophagectomie mini-invasive
In a prospective multicenter randomized clinical trial in this issue of JAMA Surgery, Wang and colleagues compared the survival and safety of neoadjuvant chemoradiotherapy (nCRT) followed by minimally invasive esophagectomy with that of neoadjuvant chemotherapy (nCT) followed by minimally invasive esophagectomy for patients with locally advanced esophageal squamous cell carcinoma. The primary outcome of this randomized clinical trial is 3-year survival, while postoperative morbidity, mortality, and pathologic response are secondary outcomes.Between January 2017 and December 2018, 132 patients were enrolled in each group, but only 112 patients in the nCRT group and 104 in the nCT group completed the protocol. The interim 1-year survival rates were similar in the 2 groups: 87.1% in the nCRT group and 82.6% in the nCT group (P = .30). The postoperative complication rates and mortality rates were also similar in the 2 groups: 47.4% postoperative complication rate and 3.5% mortality rate in the nCRT group vs 42.6% postoperative complication rate and 2.8% mortality rate in the nCT group. After nCRT, the number of lymph nodes involved was lower and the ypTNM stage was better. The authors concluded in this interim analysis that, while nCRT does not increase morbidity or mortality compared with nCT, it is associated with a higher rate of negative lymph nodes and a better ypTNM stage.
JAMA Surgery , éditorial, 2020