Delayed surgery results in a lower survival rate for esophageal cancer

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What does your post show?

– In the curative treatment of esophageal cancer, pretreatment with radiation and cytostatics is performed followed by major surgery. In recent years, supported only by observational studies, practice has changed from surgery within six weeks of completion of pretreatment to surgery up to twelve weeks thereafter. We have now validated it in a multicenter randomized study which gives the best results. Our hypothesis was that waiting longer would result in better recovery for patients who would have fewer and milder complications and who would also have better oncological outcomes due to better tumor regression with longer waiting. Quite unexpectedly, the study showed no difference in tumor regression or other pathologic outcomes, and showed significantly worse survival with delayed waiting, he says. Magnus Nelsonprofessor at the Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, who led the study.

Why are results important?

The results showed that the current international practice of late surgery leads to worse survival compared to early surgery. Our findings are likely to influence international practice, says Magnus Nilsson.

How was the study conducted?

– 249 patients with resectable stage of locally advanced esophageal cancer after undergoing prior radiation and cytostatic therapy were included. They were randomized to receive surgery either at 4-6 weeks or at 10-12 weeks. The primary outcome was complete histological response. Survival, quality of life, nutritional status and complications of surgery were secondary outcomes.

What’s the next step in your research?

– For squamous cell carcinoma of the esophagus, which is one of the two types, there are good chances of recovery without surgery. We are now conducting a large international multicenter study, the so-called NEEDS study, where we compare the current standard treatment (planned surgery) with primarily non-surgical treatment with higher dose cytostatics and radiation followed by close monitoring and surgery only when really needed for local tumor control. . The hypothesis is that primarily non-surgical treatment leads to survival at the same level, but with a better quality of life, concludes Magnus Nilsson.

The present study was carried out in collaboration with university hospitals in Sweden, Norway and Germany and was mainly funded by the Cancer Foundation and the Radiumhemmet and Stockholm Region Funds (ALF Funds). The researchers state that there is no conflict of interest.

Publishing

“Oncological outcomes of standard time versus extended time to surgery after neoadjuvant chemotherapy for esophageal cancer in the multicenter, randomized, controlled NeoRes II trial“, K. Nilsson, F. Klevebro, B. Sunde, I. Rouvelas, M. Lindblad, E. Szabo, I. Halldestam, U. Smedh, B. Wallner, J. Johansson, G. Johnsen, E. K. Aahlin, H ..-O. Johannissen, J. Alexandersson von Döpplin, J. Hjortlund, N. Wang, Y. Zhang, D. Borg, A. Quaas, I. Bartila, C. Bruns, W. Schröder and M. Nilsson, Annals of Oncology, Online 30 August 2023, doi: 10.1016/j.annonc.2023.08.010.