Does neoadjuvant chemotherapy improve survival in patients with resectable thoracic oesophageal cancer?
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether neoadjuvant chemotherapy improves survival in patients with resectable oesophageal cancer. Altogether 685 papers were identified using the below mentioned search. Nine represented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group, relevant outcomes and weaknesses were tabulated. We conclude that combining neoadjuvant chemotherapy with surgery for resectable thoracic oesophageal cancer has theoretical appeal and may offer a modest survival advantage compared to surgery alone. The most recent meta-analysis and the largest randomised trial of 804 patients demonstrated an absolute survival advantage of around 7-9% at two years which just reached statistical significance. Benefit was less clear for squamous cell carcinoma than adenocarcinoma and the second largest randomised trial did not demonstrate a significant benefit.
Department of Cardiothoracic Surgery (Level 9), Western Infirmary Glasgow, Dumbarton Road, Glasgow, G11 6NT, UK. drrajashahzad@hotmail.com
Shahzad G
SG
Raja
Kareem
K
Salhiyyah
Kumaresan
K
Nagarajan
D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D019985:Benchmarking; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D016629:Esophagectomy; D019317:Evidence-Based Medicine; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D000970:Antineoplastic Agents