Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer

作者：David Cunningham, William Allum, Sally Patricia Stenning, Jeremy N. Thompson, Cornelis J.�H. van de Velde, Marianne C. Nicolson, J. Howard Scarffe, Fiona J. Lofts, Stephen J. Falk, Timothy J. Iveson, David B. Smith, Ruth Elizabeth Langley, Monica Verma, Simon Weeden, Yu Jo Chua · 发表于：New England Journal of Medicine · 年份：2006 · DOI：10.1056/nejmoa055531 · 被引用次数：6431 · 研究领域：Gastric Cancer Management and Outcomes、Esophageal Cancer Research and Treatment、Gastrointestinal Tumor Research and Treatment

BACKGROUND: A regimen of epirubicin, cisplatin, and infused fluorouracil (ECF) improves survival among patients with incurable locally advanced or metastatic gastric adenocarcinoma. We assessed whether the addition of a perioperative regimen of ECF to surgery improves outcomes among patients with potentially curable gastric cancer. METHODS: We randomly assigned patients with resectable adenocarcinoma of the stomach, esophagogastric junction, or lower esophagus to either perioperative chemotherapy and surgery (250 patients) or surgery alone (253 patients). Chemotherapy consisted of three preoperative and three postoperative cycles of intravenous epirubicin (50 mg per square meter of body-surface area) and cisplatin (60 mg per square meter) on day 1, and a continuous intravenous infusion of fluorouracil (200 mg per square meter per day) for 21 days. The primary end point was overall survival. RESULTS: ECF-related adverse effects were similar to those previously reported among patients with advanced gastric cancer. Rates of postoperative complications were similar in the perioperative-chemotherapy group and the surgery group (46 percent and 45 percent, respectively), as were the numbers of deaths within 30 days after surgery. The resected tumors were significantly smaller and less advanced in the perioperative-chemotherapy group. With a median follow-up of four years, 149 patients in the perioperative-chemotherapy group and 170 in the surgery group had died. As compared with the...