Neoadjuvant chemoradiotherapy for esophageal carcinoma: a meta-analysis.
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.
Greer
Sarah E
SE
Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. sarah.greer@hitchcock.org
Goodney
Philip P
PP
Sutton
John E
JE
Birkmeyer
John D
JD
D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000628:therapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000628:therapy*; D006801:Humans; D020360:Neoadjuvant Therapy; D015996:Survival Rate