Preoperative radiotherapy in esophageal carcinoma: a meta-analysis using individual patient data (Oesophageal Cancer Collaborative Group).
OBJECTIVE
The existing randomized evidence has failed to conclusively demonstrate the benefit or otherwise of preoperative radiotherapy in treating patients with potentially resectable esophageal carcinoma. This meta-analysis aimed to assess whether there is benefit from adding radiotherapy prior to surgery.


METHODS
This quantitative meta-analysis included updated individual patient data from all properly randomized trials (published or unpublished) comprising 1147 patients (971 deaths) from five randomized trials.


RESULTS
With a median follow-up of 9 years, the hazard ratio (HR) of 0.89 (95% CI 0.78-1.01) suggests an overall reduction in the risk of death of 11% and an absolute survival benefit of 3% at 2 years and 4% at 5 years. This result is not conventionally statistically significant (p = 0.062). No clear differences in the size of the effect by sex, age, or tumor location were apparent.


CONCLUSIONS
Based on existing trials, there was no clear evidence that preoperative radiotherapy improves the survival of patients with potentially resectable esophageal cancer. These results indicate that if such preoperative radiotherapy regimens do improve survival, then the effect is likely to be modest with an absolute improvement in survival of around 3 to 4%. Trials or a meta-analysis of around 2000 patients would be needed to reliably detect such an improvement (15-->20%).
Arnott
S J
SJ
St. Bartholomew's Hospital, London, UK.
Duncan
W
W
Gignoux
M
M
Girling
D J
DJ
Hansen
H S
HS
Launois
B
B
Nygaard
K
K
Parmar
M K
MK
Roussel
A
A
Spiliopoulos
G
G
Stewart
L A
LA
Tierney
J F
JF
Mei
W
W
Rugang
Z
Z
D002277:Carcinoma / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic