Elsevier

Surgery

Volume 137, Issue 2, February 2005, Pages 172-177
Surgery

Original communication
Neoadjuvant chemoradiotherapy for esophageal carcinoma: A meta-analysis

https://doi.org/10.1016/j.surg.2004.06.033Get rights and content

Background

The effectiveness in improving survival of neoadjuvant chemoradiotherapy (NCRT) in patients undergoing surgery for esophageal carcinoma remains unclear.

Methods

MEDLINE, the Cochrane Database of Systematic Reviews, BIOSIS Previews, and other resources were searched from January 1966 through January 2003. Randomized trials were selected on the basis of study design (NCRT followed by surgery vs surgery alone). Of 21 potential studies identified by abstract review, 6 (29%) met the inclusion criteria.

Results

Across 6 studies, a total of 374 patients underwent NCRT followed by surgery and 364 underwent surgery alone. In 5 of the 6 studies in our meta-analysis, there was a small, non—statistically significant trend toward improved survival with NCRT. Only 1 study demonstrated a statistically significant benefit to NCRT. In our summary measure for all 6 studies, we found a small, non—statistically significant trend toward improved long-term survival in the NCRT followed by surgery group (relative risk of death in the NCRT group [RR], 0.86; 95% confidence interval [CI], 0.74 to 1.01; P = .07).

Conclusions

NCRT followed by surgery is associated with a small, non–statistically significant improvement in overall survival. Whether this benefit is sufficient to warrant the considerable expense and risks associated with NCRT should be the subject of future larger randomized trials.

Section snippets

Data sources

Data sources included studies that contained original data examining the effect of neoadjuvant therapy on overall survival in esophageal cancer. The MEDLINE database was searched from January 1966 through January 2003, using the terms “esophageal neoplasm,” “carcinoma,” “adjuvant,” “chemotherapy,” “radiotherapy,” and “combined modality therapy” (Fig 1). Further articles were identified from the reference sections of relevant studies, letters, editorials, comments, and books. This strategy was

Study characteristics

We identified 6 studies that met our inclusion criteria (Table I).15, 16, 17, 18, 19, 20 Across these studies, a total of 374 patients were treated with NCRT followed by surgery and 364 patients were treated with surgery alone. Only 2 of the 6 studies19, 20 included patients with adenocarcinoma; most focused on squamous cell carcinoma. Although nearly all patients in the surgery-alone arm completed surgery, only 72% to 97% of patients in the NCRT followed by the surgery arm were able to

Discussion

We performed a meta-analysis of 6 randomized controlled trials comparing NCRT followed by surgery versus surgery alone for treating esophageal cancer. In 5 of the 6 studies in our meta-analysis there was a small, non–statistically significant trend toward improved survival with NCRT. The remaining study showed a small, statistically significant benefit of NCRT. Our summary measure, incorporating data from 6 studies and more than 700 patients, revealed a small, non–statistically significant

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