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A new study published this month finally answers the question of how best to treat people with cancer of the oesophagus. Australian researchers found that there is a better chance of survival if patients have chemotherapy and radiation therapy given together just before surgery, than surgery alone.

The analysis, carried out by the Australasian Gastro-Intestinal Trials Group (AGITG), Sydney, was published in the prestigious medical journal Lancet Oncology earlier this month. It analysed data from many clinical trials and its findings are set to finally establish the standard treatment approach to localised oesophageal cancer, around the world.

"Cancer of the oesophagus is a difficult disease with poor long-term survival rates. At present only 20 percent of people who have surgery survive to five years," Associate Professor Mark Smithers, lead AGITG surgical author and Brisbane based oesophageal surgeon explained. "It was clear that although surgical practices have improved over the years, we had to do more to improve the odds for our patients."

A recent poll of Australian hospitals showed that patients have been treated with a variety of regimens including: surgery alone, chemotherapy before surgery or a combination of chemotherapy and radiation therapy before surgery. "Doctors just simply weren’t certain which treatment regimen was best for their patients," A/Prof. Smithers said.

"The AGITG analysis is the first to conclusively show that there is a 14 percent improvement in survival if patients receive concurrent chemotherapy and radiation therapy before surgery to help prevent the spread of cancerous tumours in their oesophagus, compared to surgery alone," A/Prof. Smithers said. "If they are unfit for radiation therapy, chemotherapy alone before surgery also gives a lower but improved survival rate than surgery alone."

Internationally there have been seven research groups, in addition to the AGITG, who have conducted clinical studies to answer the question of the role of concurrent chemotherapy and radiation therapy before surgery in localised oesophageal cancer without any conclusive results. Associate Professor Val Gebski, lead author of this analysis and AGITG Group Statistician, explained that "over the last 25 years there have been many small clinical trials, including our own, trying to answer the question of what is the best treatment standard for oesophageal cancer, but each was too small to reach any definitive conclusions."

"We gathered and combined all the available data from eighteen of these small clinical comparisons and analysed them to find that there were real benefits from administering chemotherapy and concurrent radiation therapy just before surgery.

Chemotherapy sensitised the cancer cells and together with the radiation therapy produces a more effective way to kill them. This resulted in shrinkage of the tumour, making surgery more successful and thus leading to a longer life expectancy for the patient. This finding, from the detailed data analysis, is a truly significant break-through in our understanding of the optimal treatment of patients with oesophageal cancer," A/Prof. Gebski said.

The AGITG will continue to explore key unanswered questions to develop improved treatment practices by trialling new and more targeted chemotherapy agents to further improve treatment results in patients with oesophageal cancer. Please visit www.gicancer.org.au