Comparison of Systematic Surgery Versus Surveillance and Rescue Surgery in Operable Oesophageal Cancer With a Complete Clinical Response to Radiochemotherapy

SYSTEMATIC SURGERY VERSUS SURVEILLANCE AND RESCUE SURGERY IN OPERABLE CANCER OF THE OESOPHAGUS WITH A COMPLETE CLINICAL RESPONSE TO RADIOCHEMOTHERAPY

Step 1: Inclusion of eligible patients to carry out a translational search for prognostic and predictive markers of Complete Clinical Response and Pathologic Complete Response (using blood samples and diagnostic biopsies) and to collect data on radiochemotherapy and its toxicity.

The trial will evaluate strategies after neoadjuvant treatment and not RCT protocols. The RCT will thus be chosen by the investigator from published effective schemes in a pre-operative setting or in patients not undergoing surgery.

Evaluation of the response 5 to 6 weeks after the RCT.

Step 2: Randomisation in patients with a complete clinical response:

Arm A: Systematic surgery Arm B: Surveillance and rescue surgery in cases with resectable loco-regional recurrence

Patients not eligible for randomisation will have the possibility to participate in a specific study (information can be obtained from the SAKK group (Switzerland Group Clinical Research on Cancer)).

Inclusion Criteria:

• Epidermoid carcinoma (EC) or adenocarcinoma of the thoracic oesophagus or adenocarcinoma of the oesogastric junction (Siewert type I or II) proven histologically
• Stage cT2 N1-3 M0 or cT3-T4a N0 or N1-3 M0 after a full investigation
• Patient considered operable with a curative intent and scheduled to undergo first-line radiochemotherapy in a multidisciplinary meeting
• Age ≥ 18 years < 75 years
• Patient with national health insurance cover and who has provided written informed consent for the clinical and biological studies.

Exclusion Criteria:

• Cancer of the cervical oesophagus (15 to 19 cm from the dental arches)
• Weight loss > 15% at the recruitment with no improvement after nutritional support
• Serious comorbidity threatening survival in the short term
• Contra-indication for radiochemotherapy
• Other uncured malignant disease in the 5 previous years (except for in situ cervical carcinoma and treated non-melanotic skin cancers)
• Absence of effective contraception in patients (men or women) able to procreate, pregnant or breast-feeding women
• Impossibility to follow the trial
• Legal disqualification (patients in custody or under guardianship)