Upper GI 2017
3/28/2017
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
3-year survival (95% CI) R0
57% (52%, 61%) 30% (24%, 36%)
Overall post-operative survival (all patients)
R1
1.00
R2
17% (6%, 33%)
0.75
Unavailable
18% (11%, 27%)
HR (R0 vs others)
2.41 (2.02,2.88)
0.50
P-value
<0.001
0.25
Proportion surviving
0.00
0
1
2
3
4
5
6
7
8
Time from surgery (Years)
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
Alderson,Cunninghamet al ASCO 2015
OEO2 update
Progression free survival
Pathology of resected specimens
Median PFS (95% CI)
CS
S
CF
1.53 (1.29,2.74)
1.00
CF
ECX
ECX
1.78 (1.61,2.00) 0.86 (0.74,1.01)
Total
342
327
HR
0.75
P-value
0.0580
Node +ve
195 (58%)
216 (68%)
0.50
Lateral resection margin +ve
78 (25%)
83 (28%)
0.25
Proportion progression free
Size < 4cm 184 (58%)
103 (34%)
0.00
0
1
2
3
4
5
6
7
8
Time from randomisation (Years)
446 309 198 149 115 91 70 45 23 ECX 451 292 188 141 103 66 45 20 13 CF At risk
Size 4.1 – 8.0cm 99 (31%)
161 (52%)
Alderson,Cunninghamet al ASCO 2015
Allum et al J Clin Oncol 2009; 27:5062-7
MRC OEO 5 trial design
Nodal Spread
Patients with resectable
CF x2
Surgery
adenocarcinoma of oesophagus or type 1 and 2 oesophagogastric junction
TRIPLET vs. DOUBLET LONGER DURATION
ECX x4
Surgery
• 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
Alderson,Cunninghamet al ASCO 2015
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