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Article: Postoperative radiotherapy for carcinoma of the esophagus: A prospective, randomized controlled study

TitlePostoperative radiotherapy for carcinoma of the esophagus: A prospective, randomized controlled study
Authors
Issue Date1993
PublisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/surg
Citation
Surgery, 1993, v. 113 n. 2, p. 138-147 How to Cite?
AbstractMethods. A prospective, randomized controlled study of radiotherapy after resection of esophageal carcinoma was carried out in 130 patients. Patients were stratified according to whether the resection was curative or palliative and were then randomized to receive postoperative radiotherapy or no additional treatment. Sixty patients underwent curative resection; 30 each were randomized into the radiotherapy group (CR + R) and the control group (CR). Seventy patients underwent palliative resection; 35 each were randomized into the radiotherapy group (PR + R) and the control group (PR). Results. No complications occurred while the patients were undergoing radiotherapy treatment. On follow-up, complications in the intrathoracic stomach occurred in 24 patients (37%) who underwent radiotherapy compared with four patients (6%) in the control group (p < 0.0001). Seventeen of these 24 patients in the radiotherapy group had gastric ulceration and there were five deaths as a result of bleeding. Local recurrence developed significantly less frequently in the PR + R group compared with the PR group (seven patients [20%] vs 16 patients [46%]; p = 0.04); no difference was observed between CR + R and CR groups (10% and 13%, respectively). Intrathoracic recurrence occurred in fewer patients in the radiotherapy groups (CR + R and PR + R) compared with the control groups (CR and PR) (four patients vs 15 patients; p = 0.01). In patients with residual tumor in the mediastinum after resection, two (7%) of 29 patients who underwent radiotherapy died of tracheobronchial obstruction, compared with nine (33%) of 27 patients in the control groups (p = 0.03). No difference in local recurrence was observed for extrathoracic or anastomotic recurrence. Distant metastasis developed in 12 patients (40%) in the CR + R group, nine patients (30%) in the CR group (p = 0.59), 24 patients (69%) in the PR + R group, and 18 patients (51%) in the PR group (p = 0.22). The time of onset of metastasis was 5.1 months for the PR + R group, which was shorter than the 8.5 months for the PR group (p = 0.05). The time of onset of metastasis was similar for the CR + R and CR groups (9.9 months and 11.0 months, respectively; p = 0.76). The overall median survival of patients after postoperative radiotherapy (CR + R and PR + R) was 8.7 months, which was shorter than the 15.2 months for the control groups (CR and PR) (p = 0.02). Conclusions. The shorter survival of patients who underwent postoperative radiotherapy was the result of irradiation-related death and the early appearance of metastatic diseases. The role of postoperative radiotherapy is therefore limited to a specific group of patients with residual tumor in the mediastinum after operation, for whom radiotherapy can significantly reduce the incidence of local recurrence obstructing the tracheobronchial tree.
Persistent Identifierhttp://hdl.handle.net/10722/172694
ISSN
2015 Impact Factor: 3.309
2015 SCImago Journal Rankings: 1.620
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorFok, Men_HK
dc.contributor.authorSham, JSTen_HK
dc.contributor.authorChoy, Den_HK
dc.contributor.authorCheng, SWKen_HK
dc.contributor.authorWong, Jen_HK
dc.date.accessioned2012-10-30T06:24:20Z-
dc.date.available2012-10-30T06:24:20Z-
dc.date.issued1993en_HK
dc.identifier.citationSurgery, 1993, v. 113 n. 2, p. 138-147en_HK
dc.identifier.issn0039-6060en_HK
dc.identifier.urihttp://hdl.handle.net/10722/172694-
dc.description.abstractMethods. A prospective, randomized controlled study of radiotherapy after resection of esophageal carcinoma was carried out in 130 patients. Patients were stratified according to whether the resection was curative or palliative and were then randomized to receive postoperative radiotherapy or no additional treatment. Sixty patients underwent curative resection; 30 each were randomized into the radiotherapy group (CR + R) and the control group (CR). Seventy patients underwent palliative resection; 35 each were randomized into the radiotherapy group (PR + R) and the control group (PR). Results. No complications occurred while the patients were undergoing radiotherapy treatment. On follow-up, complications in the intrathoracic stomach occurred in 24 patients (37%) who underwent radiotherapy compared with four patients (6%) in the control group (p < 0.0001). Seventeen of these 24 patients in the radiotherapy group had gastric ulceration and there were five deaths as a result of bleeding. Local recurrence developed significantly less frequently in the PR + R group compared with the PR group (seven patients [20%] vs 16 patients [46%]; p = 0.04); no difference was observed between CR + R and CR groups (10% and 13%, respectively). Intrathoracic recurrence occurred in fewer patients in the radiotherapy groups (CR + R and PR + R) compared with the control groups (CR and PR) (four patients vs 15 patients; p = 0.01). In patients with residual tumor in the mediastinum after resection, two (7%) of 29 patients who underwent radiotherapy died of tracheobronchial obstruction, compared with nine (33%) of 27 patients in the control groups (p = 0.03). No difference in local recurrence was observed for extrathoracic or anastomotic recurrence. Distant metastasis developed in 12 patients (40%) in the CR + R group, nine patients (30%) in the CR group (p = 0.59), 24 patients (69%) in the PR + R group, and 18 patients (51%) in the PR group (p = 0.22). The time of onset of metastasis was 5.1 months for the PR + R group, which was shorter than the 8.5 months for the PR group (p = 0.05). The time of onset of metastasis was similar for the CR + R and CR groups (9.9 months and 11.0 months, respectively; p = 0.76). The overall median survival of patients after postoperative radiotherapy (CR + R and PR + R) was 8.7 months, which was shorter than the 15.2 months for the control groups (CR and PR) (p = 0.02). Conclusions. The shorter survival of patients who underwent postoperative radiotherapy was the result of irradiation-related death and the early appearance of metastatic diseases. The role of postoperative radiotherapy is therefore limited to a specific group of patients with residual tumor in the mediastinum after operation, for whom radiotherapy can significantly reduce the incidence of local recurrence obstructing the tracheobronchial tree.en_HK
dc.languageengen_US
dc.publisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/surgen_HK
dc.relation.ispartofSurgeryen_HK
dc.subject.meshAdenocarcinoma - Mortality - Radiotherapy - Secondary - Surgeryen_US
dc.subject.meshCarcinoma, Squamous Cell - Mortality - Radiotherapy - Secondary - Surgeryen_US
dc.subject.meshCombined Modality Therapyen_US
dc.subject.meshEsophageal Neoplasms - Mortality - Radiotherapy - Surgeryen_US
dc.subject.meshFemaleen_US
dc.subject.meshFollow-Up Studiesen_US
dc.subject.meshHumansen_US
dc.subject.meshLength Of Stayen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshNeoplasm Recurrence, Localen_US
dc.subject.meshProspective Studiesen_US
dc.subject.meshRadiation Injuries - Etiologyen_US
dc.subject.meshSurvival Rateen_US
dc.titlePostoperative radiotherapy for carcinoma of the esophagus: A prospective, randomized controlled studyen_HK
dc.typeArticleen_HK
dc.identifier.emailCheng, SWK: wkcheng@hkucc.hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hken_HK
dc.identifier.authorityCheng, SWK=rp00374en_HK
dc.identifier.authorityWong, J=rp00322en_HK
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.pmid8430362-
dc.identifier.scopuseid_2-s2.0-0027474617en_HK
dc.identifier.volume113en_HK
dc.identifier.issue2en_HK
dc.identifier.spage138en_HK
dc.identifier.epage147en_HK
dc.identifier.isiWOS:A1993KL37600005-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridFok, M=7005879262en_HK
dc.identifier.scopusauthoridSham, JST=7101655565en_HK
dc.identifier.scopusauthoridChoy, D=7102939127en_HK
dc.identifier.scopusauthoridCheng, SWK=7404684779en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK

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