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Preoperative Chemotherapy Shows Promise in Esophageal Cancer

Preoperative Chemotherapy Shows Promise in Esophageal Cancer

SAN FRANCISCO—Two cycles of preoperative cisplatin (Platinol) and
fluorouracil (5-FU) may improve survival in patients with resectable esophageal
cancer, compared with surgery alone, according to a large study from the United
Kingdom presented at the 37th Annual Meeting of the American Society of
Clinical Oncology (ASCO abstract 502).

Peter Clark, MD, of the Medical Research Council (MRC) Clinical Trials Unit,
London, UK, presented the results of a randomized controlled trial conducted by
the UK MRC Upper GI Tract Cancer Group.

Between 1992 and 1998, the study enrolled 802 previously untreated patients
with resectable esophageal cancer. The average patient was a 62-year old man
with adenocarcinoma of the lower third of the esophagus.

"Tumors of the lower esophagus have become relatively common among
white males in their 50s, for reasons that are unclear," Dr. Clark said at
a press conference. "This cancer is tough to treat because it is
frequently inoperable and frequently presents with distant spread."

He noted that small institutional studies have suggested that chemotherapy
may increase the chances for complete resection and may reduce the risk of
secondary spread.

Patients were randomized to surgical resection or to two 4-day cycles 3
weeks apart of cisplatin 80 mg/m² by 4-hour infusion plus fluorouracil 1
g/m²/d
by continuous infusion for 4 days, followed by resection. This chemotherapy
regimen was standard treatment for esophageal cancer during the early 1990s,
Dr. Clark commented.

Resection was considered complete in 78% of the chemotherapy group vs 70% of
the surgical group (P < .001): 10% and 11% of patients, respectively, died
within 30 days of resection.

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