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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