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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Oncological outcomes of standard versus prolonged time to surgery after neoadjuvant chemoradiotherapy for oesophageal cancer in the multicentre, randomised, controlled NeoRes II trial

Nilsson, K. (författare): 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

Klevebro, F. (författare): 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

Sunde, B. (författare): Karolinska Institutet

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Rouvelas, I. (författare): Karolinska Institutet

Lindblad, M. (författare): 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

Szabo, E. (författare): Department of Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro,Orebro Univ Hosp, Sweden

Halldestam, Ingvar (författare): University Hospital of Linköping, Linköping,Region Östergötland, Kirurgiska kliniken US

Smedh, U. (författare): Department of Surgery, Sahlgrenska University Hospital, Gothenburg,Sahlgrens Univ Hosp, Sweden

Wallner, Bengt, 1962- (författare): Umeå universitet,Kirurgi,Umea Univ, Sweden

Johansson, J. (författare): Department of Surgery, Skåne University Hospital, Lund, Sweden,Skane Univ Hosp, Sweden,Oslo Univ Hosp, Norway

Johnsen, G. (författare): Department of Gastrointestinal Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway,Univ Trondheim Hosp, Norway

Aahlin, E.K. (författare): Department of GI and HPB Surgery, University Hospital of Northern Norway, Tromsø,Univ Hosp Northern Norway, Norway

Johannessen, H.-O. (författare): Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway

Alexandersson von Döbeln, G. (författare): Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm; Medical Unit of Head, Neck, Lung and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden,Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden

Hjortland, G.O. (författare): Department of Oncology, Oslo University Hospital, Oslo, Norway,Oslo Univ Hosp, Norway

Wang, N. (författare): Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm,Karolinska Univ Hosp, Sweden

Shang, Y. (författare): Karolinska Institutet

Borg, D. (författare): Department of Oncology, Skåne University Hospital, Lund, Sweden,Skane Univ Hosp, Sweden

Quaas, A. (författare): Institute of Pathology, University of Cologne, Cologne,Univ Cologne, Germany

Bartella, I. (författare): Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany,Univ Hosp Cologne, Germany

Bruns, C. (författare): Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany,Univ Hosp Cologne, Germany

Schröder, W. (författare): Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany,Univ Hosp Cologne, Germany

Nilsson, M. (författare): Karolinska Institutet

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Elsevier, 2023
2023
Engelska.
Ingår i: Annals of Oncology. - : Elsevier. - 0923-7534 .- 1569-8041. ; 34:11, s. 1015-1024

Relaterad länk:: https://doi.org/10.1...; visa fler...; https://umu.diva-por... (primary) (Raw object); https://urn.kb.se/re...; https://doi.org/10.1...; https://urn.kb.se/re...; http://kipublication...; visa färre...

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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.

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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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