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TheRoyalMarsden
2011-2015 update
GOJ and oesophageal only
10/62 adenocarcinoma (16%)
8/62 circumferential, 2/62 distal/proximal
1 previously treated on advanced disease protocol
+ CRT
70% Siewert 1, 30% Siewert 2 (vs 36% Siewert 1
in margin negative)
Pre-op CT demonstrated stable disease in 30%,
partial response in 70%
Survival by R0 status
0.00
0.25
0.50
0.75
1.00
Proportion surviving
91 46 21 12 5 3 1 1 0
Unavailable
29 20 6 5 4 2 2 2 1
R2
232 149 89 62 39 22 17 11 4
R1
442 381 279 223 163 122 79 48 20
R0
At risk
0
1
2
3
4
5
6
7
8
Time from surgery (Years)
Overall post-operative survival (all patients)
3-year survival (95% CI)
R0
57% (52%, 61%)
R1
30% (24%, 36%)
R2
17% (6%, 33%)
Unavailable
18% (11%, 27%)
HR (R0 vs others)
2.41 (2.02,2.88)
P-value
<0.001
Alderson,Cunninghamet al ASCO 2015
Progression free survival
Median PFS (95% CI)
CF
1.53 (1.29,2.74)
ECX
1.78 (1.61,2.00)
HR
0.86 (0.74,1.01)
P-value
0.0580
0.00
0.25
0.50
0.75
1.00
Proportion progression free
446 309 198 149 115 91 70 45 23
ECX
451 292 188 141 103 66 45 20 13
CF
At risk
0
1
2
3
4
5
6
7
8
Time from randomisation (Years)
CF
ECX
Alderson,Cunninghamet al ASCO 2015
OEO2 update
Pathology of resected specimens
CS
S
Total
342
327
Node +ve
195 (58%)
216 (68%)
Lateral
resection
margin +ve
78 (25%)
83 (28%)
Size < 4cm 184 (58%)
103 (34%)
Size 4.1 – 8.0cm 99 (31%)
161 (52%)
Allum et al J Clin Oncol
2009; 27:5062-7
Nodal Spread
MRC OEO 5 trial design
•
Primary endpoint: overall survival
•
Final recruitment: 897 patients (this will provide 74%
power to detect a 7% improvement in 3 year survival (from
30% to 37%), or 84% power to detect an 8% improvement
(to 38%)
•
Recruitment completed 31
st
October 2011
CF x2
Surgery
Patients with
resectable
adenocarcinoma
of oesophagus or
type 1 and 2
oesophagogastric
junction
ECX x4
Surgery
TRIPLET vs. DOUBLET
LONGER DURATION
Alderson,Cunninghamet al ASCO 2015