title: Neoadjuvant chemoradiotherapy for esophageal cancer: a review of meta-analyses.
abstract: BACKGROUND
  Most randomized controlled trials (RCTs) that have compared neoadjuvant chemoradiation followed by surgery with surgery alone for locally advanced esophageal cancer have shown no difference in survival between the two treatments. Meta-analyses on neoadjuvant chemoradiation in esophageal cancer, however, are discordant.
  
  
  METHODS
  For the present study, published meta-analyses on neoadjuvant chemoradiation for esophageal cancer were identified from the PubMed database and critically appraised in order to make a judgment on the applicability of neoadjuvant chemoradiation in clinical practice and decision making.
  
  
  RESULTS
  Two of the six meta-analyses examined did not show a significant survival benefit in patients with resectable esophageal cancer. Differences in the studies included and statistical methods applied might account for this. Moreover, there was heterogeneity between the RCTs included in the meta-analyses with regard to the patients included, tumor histology, and radiotherapy and chemotherapy regimes. Also, surgical technique was not uniform. No data on individual patients were available for most meta-analyses. The RCTs included in the meta-analyses were of inadequate sample size. All were started in the nineties, and hence methods for diagnosis, staging, treatment delivery, and outcome measurement reflect clinical practice during that decade.
  
  
  CONCLUSIONS
  The current data on neoadjuvant chemoradiation for esophageal cancer strongly indicate the need for designing future high-quality trials that will contribute to a better understanding of the role of neoadjuvant treatment for resectable cancer of the esophagus and help to identify patient subgroups that would benefit most.
authors.affiliation: Department of Surgery, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. b.wijnhoven@erasmusmc.nl
authors.forename: Bas P L
authors.initials: BP
authors.lastname: Wijnhoven
authors.forename: Jan J B
authors.initials: JJ
authors.lastname: van Lanschot
authors.forename: Hugo W
authors.initials: HW
authors.lastname: Tilanus
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Ate
authors.initials: A
authors.lastname: van der Gaast
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D015201:Meta-Analysis as Topic; D020360:Neoadjuvant Therapy; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic