“I received chemotherapy and radiation before surgery, will this work better than straight surgery?” Many people have this question. This article will help you answer them.
For esophageal cancer, preoperative neoadjuvant therapy is better than surgery alone.
In a study led by Chinese experts and code-named NEOCRTEC 5010, 451 patients were recruited between 2007 and 2014 and randomized equally to the “radiotherapy + surgery group” and the “surgery alone group.
The study found that the R0 resection rate (i.e., the probability of a clean surgical cut) was 98.4% and 91.2% in the two groups, respectively; median overall survival was 100 months and 67 months, respectively; and median disease-free survival (DFS), which is the absence of any residual disease in the body after surgery, was 100 months and 42 months, respectively. The median disease-free survival was 100 and 42 months, respectively.
Then looking at adverse events, the incidence of postoperative complications was similar in both groups, but the incidence of arrhythmias was higher in the radiotherapy group (13% vs 4%).
Which is better, preoperative radiotherapy or chemotherapy alone?
Studies have found that preoperative radiotherapy is more effective than preoperative chemotherapy. The former has a pathologically Complete Remission (pCR) rate of 20% to 35%. In layman’s terms, this means that the probability of not seeing any cancer cells in the surgically resected specimen is much higher than that produced by neoadjuvant chemotherapy only.
If you have a “complete pathologic remission,” your prognosis is very good.
However, whether you choose chemotherapy alone or radiotherapy before surgery, your doctor will have to take into account your own situation, such as your age and physical condition, to determine whether you can tolerate the “combination” of radiotherapy + chemotherapy and how likely you are to have complications from treatment. After all, the superposition of radiation and chemotherapy toxicity can lead to increased acute adverse effects; it can also lead to reduced treatment dose or non-adherence to treatment and increased surgical complications, thus offsetting the survival benefits of combined radiotherapy.
In conclusion, the premise of neoadjuvant therapy is that the underlying lesion is resectable and that surgery will not be delayed or rendered inoperable because of the side effects associated with neoadjuvant therapy. Therefore, effectiveness and safety are important considerations, and the ability to improve long-term survival is the “gold standard.
The advice to you is to work with your doctor and tell him or her what you think is reasonable, and he or she will take into account your wishes, your concomitant disease, and many other factors.
Co-written by Dr. You Jing Dr. Liu Chang
, Peking University Cancer Hospital