title: Neoadjuvant treatment for resectable cancer of the esophagus and the gastroesophageal junction: a meta-analysis of randomized clinical trials.
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.
authors.affiliation: Division of Surgical Oncology, Sylvester Cancer Center, University of Miami, Miami, Florida, USA.
authors.forename: Ioannis G
authors.initials: IG
authors.lastname: Kaklamanos
authors.forename: Gail R
authors.initials: GR
authors.lastname: Walker
authors.forename: Kristian
authors.initials: K
authors.lastname: Ferry
authors.forename: Dido
authors.initials: D
authors.lastname: Franceschi
authors.forename: Alan S
authors.initials: AS
authors.lastname: Livingstone
mesh_terms: D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery*; D004943:Esophagogastric Junction; D006801:Humans; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic