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Oncological outcome...
Oncological outcomes of standard versus prolonged time to surgery after neoadjuvant chemoradiotherapy for oesophageal cancer in the multicentre, randomised, controlled NeoRes II trial
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- Nilsson, K. (author)
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm; Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm,Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden
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- Klevebro, F. (author)
- Karolinska Institutet
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- Sunde, B. (author)
- Karolinska Institutet
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- Rouvelas, I. (author)
- Karolinska Institutet
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- Lindblad, M. (author)
- Karolinska Institutet
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- Szabo, E. (author)
- Department of Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro,Orebro Univ Hosp, Sweden
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- Halldestam, Ingvar (author)
- University Hospital of Linköping, Linköping,Region Östergötland, Kirurgiska kliniken US
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- Smedh, U. (author)
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg,Sahlgrens Univ Hosp, Sweden
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- Wallner, Bengt, 1962- (author)
- Umeå universitet,Kirurgi,Umea Univ, Sweden
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- Johansson, J. (author)
- Department of Surgery, Skåne University Hospital, Lund, Sweden,Skane Univ Hosp, Sweden,Oslo Univ Hosp, Norway
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- Johnsen, G. (author)
- Department of Gastrointestinal Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway,Univ Trondheim Hosp, Norway
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- Aahlin, E.K. (author)
- Department of GI and HPB Surgery, University Hospital of Northern Norway, Tromsø,Univ Hosp Northern Norway, Norway
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- Johannessen, H.-O. (author)
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
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- Alexandersson von Döbeln, G. (author)
- Karolinska Institutet
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- Hjortland, G.O. (author)
- Department of Oncology, Oslo University Hospital, Oslo, Norway,Oslo Univ Hosp, Norway
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- Wang, N. (author)
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm,Karolinska Univ Hosp, Sweden
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- Shang, Y. (author)
- Karolinska Institutet
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- Borg, D. (author)
- Department of Oncology, Skåne University Hospital, Lund, Sweden,Skane Univ Hosp, Sweden
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- Quaas, A. (author)
- Institute of Pathology, University of Cologne, Cologne,Univ Cologne, Germany
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- Bartella, I. (author)
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany,Univ Hosp Cologne, Germany
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- Bruns, C. (author)
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany,Univ Hosp Cologne, Germany
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- Schröder, W. (author)
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany,Univ Hosp Cologne, Germany
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- Nilsson, M. (author)
- Karolinska Institutet
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(creator_code:org_t)
- Elsevier, 2023
- 2023
- English.
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In: Annals of Oncology. - : Elsevier. - 0923-7534 .- 1569-8041. ; 34:11, s. 1015-1024
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Abstract
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- Background: The optimal time to surgery (TTS) after neoadjuvant chemoradiotherapy (nCRT) for oesophageal cancer is unknown and has traditionally been 4-6 weeks in clinical practice. Observational studies have suggested better outcomes, especially in terms of histological response, after prolonged delay of up to 3 months after nCRT. The NeoRes II trial is the first randomised trial to compare standard to prolonged TTS after nCRT for oesophageal cancer.Patients and methods: Patients with resectable, locally advanced oesophageal cancer were randomly assigned to standard delay of surgery of 4-6 weeks or prolonged delay of 10-12 weeks after nCRT. The primary endpoint was complete histological response of the primary tumour in patients with adenocarcinoma (AC). Secondary endpoints included histological tumour response, resection margins, overall and progression-free survival in all patients and stratified by histologic type.Results: Between February 2015 and March 2019, 249 patients from 10 participating centres in Sweden, Norway and Germany were randomised: 125 to standard and 124 to prolonged TTS. There was no significant difference in complete histological response between AC patients allocated to standard (21%) compared to prolonged (26%) TTS (P = 0.429). Tumour regression, resection margins and number of resected lymph nodes, total and metastatic, did not differ between the allocated interventions. The first quartile overall survival in patients allocated to standard TTS was 26.5 months compared to 14.2 months after prolonged TTS (P = 0.003) and the overall risk of death during follow-up was 35% higher after prolonged delay (hazard ratio 1.35, 95% confidence interval 0.94-1.95, P = 0.107).Conclusion: Prolonged TTS did not improve histological complete response or other pathological endpoints, while there was a strong trend towards worse survival, suggesting caution in routinely delaying surgery for >6 weeks after nCRT.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
Keyword
- neoadjuvant chemoradiotherapy
- oesophageal adenocarcinoma
- oesophageal squamous cell carcinoma
- prolonged time
- standard time
- surgery
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Nilsson, K.
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Klevebro, F.
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Sunde, B.
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Rouvelas, I.
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Lindblad, M.
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Szabo, E.
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Halldestam, Ingv ...
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Smedh, U.
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Wallner, Bengt, ...
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Johansson, J.
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Johnsen, G.
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Aahlin, E.K.
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Johannessen, H.- ...
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Alexandersson vo ...
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Hjortland, G.O.
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Wang, N.
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Shang, Y.
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Borg, D.
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Quaas, A.
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Bartella, I.
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Bruns, C.
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Schröder, W.
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Nilsson, M.
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Surgery
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cancer and Oncol ...
- Articles in the publication
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Annals of Oncolo ...
- By the university
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Umeå University
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Linköping University
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Karolinska Institutet