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Research Letter
September 14, 2016

Comparative Effectiveness of Preoperative Treatment Regimens in Patients With Potentially Resectable Esophageal Cancer

Author Affiliations
  • 1Section of Hematology/Oncology, Department of Medicine, North Florida/South Georgia Veterans Health System and the University of Florida, Gainesville
  • 2Department of Surgery, North Florida/South Georgia Veterans Health System and the University of Florida, Gainesville
  • 3Department of Surgery, Mount Sinai Medical Center, Miami Beach, Florida

Copyright 2017 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Surg. Published online September 14, 2016. doi:10.1001/jamasurg.2016.2821

Despite potentially curative surgery, the 5-year survival rate for patients with esophageal cancer (EC) is approximately 25%, and thus, additional therapies have been explored to improve outcomes.1 Randomized trials have demonstrated improved recurrence-free survival (RFS) and overall survival (OS) in patients with EC treated with preoperative chemoradiation vs surgery alone.2,3 Historically, cisplatin-based regimens demonstrate higher tumor response rates but exhibit increased toxic effects compared with carboplatin-based regimens, which have become an attractive alternative.24 While preoperative chemoradiation with cisplatin and fluorouracil (cis/5FU) or carboplatin and paclitaxel (carbo/pac) have been studied individually in EC, comparative randomized trials are lacking. Given the cis/5FU and carbo/pac usage during 2 time periods (2005-2012 and 2011-present, respectively) at our institution, we hypothesized that despite concerns of toxic effects there would be no difference in treatment completion between cohorts, but preoperative cis/5FU would yield improved outcomes and should still be considered for patients with resectable EC.

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