Neoadjuvant Chemoradiotherapy for Resectable Esophageal Carcinoma: a Meta-analysis

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2009 Dec 17

PMID 20014464

Citations 35

Authors

Hai-Lin Jin

Hong Zhu

Ting-Sheng Ling

Hong-Jie Zhang

Rui-Hua Shi

Affiliations

Soon will be listed here.

Abstract

Aim: To compare neoadjuvant chemoradiotherapy and surgery with surgery alone for resectable esophageal carcinoma.

Methods: We used MEDLINE and EMBASE databases to identify eligible studies and manual searches were done to ensure no studies were missed. Trial validity assessment was performed and a trial quality score was assigned.

Results: Eleven randomized controlled trials (RCTs) including 1308 patients were selected. Neoadjuvant chemoradiotherapy significantly improved the overall survival compared with surgery alone. Odds ratio (OR) [95% confidence interval (CI), P value], expressed as neoadjuvant chemoradiotherapy and surgery vs surgery alone, was 1.28 (1.01-1.64, P = 0.05) for 1-year survival, 1.78 (1.20-2.66, P = 0.004) for 3-year survival, and 1.46 (1.07-1.99, P = 0.02) for 5-year survival. Postoperative mortality increased in patients treated by neoadjuvant chemoradiotherapy (OR: 1.68, 95% CI: 1.03-2.73, P = 0.04), but incidence of postoperative complications was similar in two groups (OR: 1.14, 95% CI: 0.88-1.49, P = 0.32). Neoadjuvant chemoradiotherapy lowered the local-regional cancer recurrence (OR: 0.64, 95% CI: 0.41-0.99, P = 0.04), but incidence of distant cancer recurrence was similar (OR: 0.94, 95% CI: 0.68-1.31, P = 0.73). Histological subgroup analysis indicated that esophageal squamous cell carcinoma did not benefit from neoadjuvant chemoradiotherapy, OR (95% CI, P value) was 1.16 (0.85-1.57, P = 0.34) for 1-year survival, 1.34 (0.98-1.82, P = 0.07) for 3-year survival and 1.41 (0.98-2.02, P = 0.06) for 5-year survival.

Conclusion: Neoadjuvant chemoradiotherapy can raise the survival rate of patients with esophageal adenocarcinoma.

Citing Articles

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Survival of Neoadjuvant and Adjuvant Therapy Compared With Surgery Alone for Resectable Esophageal Squamous Cell Carcinoma: A Systemic Review and Network Meta-Analysis.

Ma Z, Yuan M, Bao Y, Wang Y, Men Y, Hui Z Front Oncol. 2021; 11:728185.

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References

Khushalani N . Cancer of the esophagus and stomach. Mayo Clin Proc. 2008; 83(6):712-22. View

Parkin D, Bray F, Ferlay J, Pisani P . Global cancer statistics, 2002. CA Cancer J Clin. 2005; 55(2):74-108. DOI: 10.3322/canjclin.55.2.74. View

Miyazono F, Metzger R, Warnecke-Eberz U, Baldus S, Brabender J, Bollschweiler E . Quantitative c-erbB-2 but not c-erbB-1 mRNA expression is a promising marker to predict minor histopathologic response to neoadjuvant radiochemotherapy in oesophageal cancer. Br J Cancer. 2004; 91(4):666-72. PMC: 2364782. DOI: 10.1038/sj.bjc.6601976. View

Noguchi T, Shibata T, Fumoto S, Uchida Y, Mueller W, Takeno S . DNA-PKcs expression in esophageal cancer as a predictor for chemoradiation therapeutic sensitivity. Ann Surg Oncol. 2002; 9(10):1017-22. DOI: 10.1007/BF02574522. View

Gebski V, Burmeister B, Smithers B, Foo K, Zalcberg J, Simes J . Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol. 2007; 8(3):226-34. DOI: 10.1016/S1470-2045(07)70039-6. View

Lee J, Park S, Kim S, Jung H, Lee G, Kim J . A single institutional phase III trial of preoperative chemotherapy with hyperfractionation radiotherapy plus surgery versus surgery alone for resectable esophageal squamous cell carcinoma. Ann Oncol. 2004; 15(6):947-54. DOI: 10.1093/annonc/mdh219. View

Urba S, Orringer M, Turrisi A, Iannettoni M, Forastiere A, Strawderman M . Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol. 2001; 19(2):305-13. DOI: 10.1200/JCO.2001.19.2.305. View

Bosset J, GIGNOUX M, Triboulet J, Tiret E, Mantion G, Elias D . Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med. 1997; 337(3):161-7. DOI: 10.1056/NEJM199707173370304. View

Warnecke-Eberz U, Metzger R, Miyazono F, Baldus S, Neiss S, Brabender J . High specificity of quantitative excision repair cross-complementing 1 messenger RNA expression for prediction of minor histopathological response to neoadjuvant radiochemotherapy in esophageal cancer. Clin Cancer Res. 2004; 10(11):3794-9. DOI: 10.1158/1078-0432.CCR-03-0079. View

10.

Nygaard K, Hagen S, Hansen H, Hatlevoll R, Hultborn R, Jakobsen A . Pre-operative radiotherapy prolongs survival in operable esophageal carcinoma: a randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second Scandinavian trial in esophageal cancer. World J Surg. 1992; 16(6):1104-9; discussion 1110. DOI: 10.1007/BF02067069. View

11.

Diehl L . Radiation and chemotherapy in the treatment of esophageal cancer. Gastroenterol Clin North Am. 1991; 20(4):765-74. View

12.

Crew K, Neugut A . Epidemiology of upper gastrointestinal malignancies. Semin Oncol. 2004; 31(4):450-64. DOI: 10.1053/j.seminoncol.2004.04.021. View

13.

An F, Huang J, Xie Y, Chen S, Rong T . [A prospective study of combined chemoradiotherapy followed by surgery in the treatment of esophageal carcinoma]. Zhonghua Zhong Liu Za Zhi. 2003; 25(4):376-9. View

14.

Romagnuolo J, Scott J, Hawes R, Hoffman B, Reed C, Aithal G . Helical CT versus EUS with fine needle aspiration for celiac nodal assessment in patients with esophageal cancer. Gastrointest Endosc. 2002; 55(6):648-54. DOI: 10.1067/mge.2002.122650. View

15.

Dillman R, Herndon J, Seagren S, Eaton Jr W, Green M . Improved survival in stage III non-small-cell lung cancer: seven-year follow-up of cancer and leukemia group B (CALGB) 8433 trial. J Natl Cancer Inst. 1996; 88(17):1210-5. DOI: 10.1093/jnci/88.17.1210. View

16.

Natsugoe S, Okumura H, Matsumoto M, Uchikado Y, Setoyama T, Yokomakura N . Randomized controlled study on preoperative chemoradiotherapy followed by surgery versus surgery alone for esophageal squamous cell cancer in a single institution. Dis Esophagus. 2006; 19(6):468-72. DOI: 10.1111/j.1442-2050.2006.00615.x. View

17.

Kelsen D . Multimodality therapy for adenocarcinoma of the esophagus. Gastroenterol Clin North Am. 1997; 26(3):635-45. DOI: 10.1016/s0889-8553(05)70319-8. View

18.

Jadad A, Moore R, Carroll D, Jenkinson C, Reynolds D, Gavaghan D . Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials. 1996; 17(1):1-12. DOI: 10.1016/0197-2456(95)00134-4. View

19.

Fiorica F, Di Bona D, Schepis F, Licata A, Shahied L, Venturi A . Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis. Gut. 2004; 53(7):925-30. PMC: 1774092. DOI: 10.1136/gut.2003.025080. View

20.

Miyazaki T, Kato H, Faried A, Sohda M, Nakajima M, Fukai Y . Predictors of response to chemo-radiotherapy and radiotherapy for esophageal squamous cell carcinoma. Anticancer Res. 2005; 25(4):2749-55. View