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• W2165346879 abstract "Nearly 50% of patients with a diagnosis of oesophagogastric cancer present with overt metastatic disease, and chemotherapy is the mainstay of palliative treatment. While data from clinical trials before the 1990s were largely ineffective due to the use of single-agent chemotherapies in heterogeneous, small patient populations, more recent trials with combination chemotherapy, targeted agents, and neoadjuvant chemotherapy are more promising. With the increasing use of chemotherapy as an adjunct to surgical management, systemic chemotherapy will ultimately be used to treat the majority of patients with oesophagogastric cancer. Basis of chemotherapy In patients with advanced oesophagogastric cancer, chemotherapy clearly improves survival and quality of life compared with best supportive care alone, although the evidence is more compelling in gastric cancer specifically. 2-5 In a meta-analysis of 35 trials with a total 5726 patients with advanced gastric cancer, systemic chemotherapy was compared with best supportive care. The main finding of this analysis was that patients undergoing chemotherapy lived for an average of six months longer than those receiving best supportive care [hazard ratio (HR) 0.37, 95% confidence intervals (CI) 0.24 to 0.55]. 6 Furthermore, combination chemotherapy had better survival than single-agent chemotherapy (HR 0.82; 95% CI 0.74 to 0.90). However, this benefit was at the expense of increased toxicity. Therefore, in the absence of contraindications and concerns over toxicity, combination chemotherapy would be used as initial treatment in patients with good performance status. In contrast, oesophageal cancer is more heterogeneous and evidence supporting chemotherapy alone is less compelling. The grouping of locally advanced and metastatic disease with different pathologies (ie. squamous and adenocarcinoma) makes interpretation of results difficult. Furthermore, radiotherapy is often added for local control. A multicentre randomised French study currently accruing patients with only metastatic squamous cell oesophageal carcinoma may help to ascertain if there is a benefit of chemotherapy over best supportive care. 7 Similarly, Trans-Tasman Radiation Oncology Group (TROG) is conducting a randomised phase III study in advanced oesophageal carcinoma to compare palliative benefit in dysphagia in patients treated with radiotherapy versus" @default.
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• W2165346879 date "2011-11-01" @default.
• W2165346879 modified "2023-09-26" @default.
• W2165346879 title "Reviewing the role of cytotoxics in oesophagogastric cancer in the refractory relapsed and advanced settings" @default.
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