Monday, January 19, 2009

Neoadjuvant Chemo vs ChemoRT for GE junctional cancers

This one comes in from PG via email in regards to the newly published Stahl trial examing RT vs CTRT prior to resection in GEJ cancers:

The stats are a bit shy of the goals, but this appears to be clinically significant nonetheless. Results are consistent with the relative benefits of each treatment strategy according to the meta-analyses on this topic, but now there is a RCT.

One could argue that they did not use 'optimal' chemo (ECF), and instead used a different chemo regimen (cisplatin, fluorouracil, leucovorin), but the MAGIC trial compared chemo-surgery vs. surgery alone, so there is no direct comparison between these chemo regimens.  So, based on this RCT and meta-analyses, preop chemoRT appears to be superior in selected patients for these tumors.  No adjuvant chemo for either arm.

1 comment:

Junzo Chino said...

This is definitely an important trial to know, given the two strains of thinking on this in the US (ChemoRT) vs the UK (Chemo). An important part of this trial is that it was closed early, therefore, one can't expect significant results. However, the 3 year survival difference is impressive at 27.7% (CT) to 47.4% (CTRT) (p=.07) for such an underpowered study.