Esophageal cancer can be cured by surgery if the cancer has not yet spread. "The chances of recovery increase significantly if the operation is combined with additional therapies," says Florian Lordick, oncologist and Director of the University Cancer Center Leipzig and the Central German Cancer Center Leipzig-Jena. Various complementary treatment methods are available for this purpose - but it was previously unclear which one was actually most effective in combating the cancer.
The clinical study involved 25 institutions in Germany specializing in cancer. Patients with adenocarcinoma, the most common form of oesophageal cancer in Germany, were examined. This type of cancer develops in the lower part of the oesophagus at the junction with the stomach and is caused by rising stomach acid. This irritates the oesophagus for years and eventually causes malignant cell changes, the basis for cancer growth in the oesophagus. Obesity, smoking and alcohol consumption increase the risk of esophageal cancer. The incidence of the disease has increased dramatically in Germany in recent decades.
Better chances of survival
The specific aim of the ESOPEC study was to compare a combination of chemotherapy and radiotherapy before surgery ("CROSS") with intensified chemotherapy both before and after surgery ("FLOT"). Both methods are better than surgery alone, but CROSS was preferred worldwide," emphasizes Jens Höppner, head of the clinical trial and the University Clinic for General and Visceral Surgery at Lippe Hospital, which is affiliated with Bielefeld University.Between 2016 and 2020, 438 patients from Germany with adenocarcinoma of the oesophagus were followed up for more than four years to see how many people suffered a relapse and how many died from the disease. The results show that Patients who received FLOT chemotherapy before and after surgery had a better chance of survival than those who had only received CROSS chemotherapy and radiotherapy before surgery.
Important step for future treatment
Three years after the end of the study, 57.4 percent of patients in the FLOT group were alive compared to 50.7 percent in the CROSS group. This corresponds to a statistically significant lower risk of death for those treated with FLOT. After five years, the difference between the two groups increased further. The safety of FLOT chemotherapy was comparable to the less effective CROSS radiochemotherapy.The results show that perioperative chemotherapy significantly improves the chances of survival in esophageal cancer. Professor Lordick from Leipzig University Medicine reports that the national and international guidelines for the treatment of adenocarcinoma of the esophagus have already changed as a result of the study results. They have recently been revised for both Europe and Germany," he says. Perioperative FLOT chemotherapy is now the preferred recommended treatment method for patients with operable adenocarcinoma of the oesophagus. "This is an important step for the future treatment of esophageal cancer," says Lordick.
Original title of the publication in the New England Journal of Medicine:
,, Perioperative Chemotherapy or Preoperative Chemoradiotherapy in Esophageal Cancer" , doi: 10.1056/NEJMoa2409408
