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Neoadjuvant Treatment for Resectable Cancer of the Esophagus and the Gastroesophageal Junction: A Meta-Analysis of Randomized Clinical Trials

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Abstract

Background: There is no general agreement on the effect of neoadjuvant treatment for esophageal cancer on patient survival.

Methods: A meta-analysis was performed to determine the effect of preoperative treatment on survival of patients with resectable esophageal cancer and the effect of preoperative treatment on patient mortality. A standard variance-based method was used to derive summary estimates of the absolute difference in both 2-year survival and treatment-related mortality.

Results: Eleven randomized trials involving 2311 patients were analyzed. Preoperative chemotherapy improved 2-year survival compared with surgery alone: the absolute difference was 4.4% (95% confidence interval [CI], .3%–8.5%). Marginal evidence of heterogeneity was eliminated by restricting attention to the four most recent studies, which increased the estimate to 6.3% (95% CI, 1.8%–10.7%). For combined chemoradiotherapy, the increase was 6.4% (nonsignificant; 95% CI, −1.2%–14.0%). Treatment-related mortality increased by 1.7% with neoadjuvant chemotherapy (95% CI, −.9%—4.3%) and by 3.4% with chemoradiotherapy (95% CI, −.1%–7.3%), compared with surgery alone.

Conclusions: There seems to be a modest survival advantage for patients who receive neoadjuvant chemotherapy followed by surgery, as compared with surgery alone. There is an apparent increase in treatment-related mortality, mainly for patients who receive neoadjuvant chemoradiotherapy.

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Authors and Affiliations

  1. Division of Surgical Oncology, Sylvester Cancer Center, University of Miami, Miami, Florida

    Ioannis G. Kaklamanos MD, PhD, Kristian Ferry MD, Dido Franceschi MD & Alan S. Livingstone MD

  2. Division of Biostatistics, Sylvester Cancer Center, University of Miami, Miami, Florida

    Gail R. Walker PhD

  3. University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, Division of Surgical Oncology (310T), 1475 NW 12th Avenue, Room 3550, Miami, FL, 33136

    Dido Franceschi MD

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  1. Ioannis G. Kaklamanos MD, PhD
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  2. Gail R. Walker PhD
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  3. Kristian Ferry MD
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  4. Dido Franceschi MD
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  5. Alan S. Livingstone MD
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Correspondence to Dido Franceschi MD.

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Kaklamanos, I.G., Walker, G.R., Ferry, K. et al. Neoadjuvant Treatment for Resectable Cancer of the Esophagus and the Gastroesophageal Junction: A Meta-Analysis of Randomized Clinical Trials. Ann Surg Oncol 10, 754–761 (2003). https://doi.org/10.1245/ASO.2003.03.078

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  • DOI: https://doi.org/10.1245/ASO.2003.03.078

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