Neoadjuvant chemoradiotherapy for resectable esophageal carcinoma: a meta-analysis.
OBJECTIVE
To compare neoadjuvant chemoradiotherapy and surgery with surgery alone for resectable esophageal carcinoma.


METHODS
We used MEDLINE and EMBASE databases to identify eligible studies and manual searches were done to ensure no studies were missed. Trial validity assessment was performed and a trial quality score was assigned.


RESULTS
Eleven randomized controlled trials (RCTs) including 1308 patients were selected. Neoadjuvant chemoradiotherapy significantly improved the overall survival compared with surgery alone. Odds ratio (OR) [95% confidence interval (CI), P value], expressed as neoadjuvant chemoradiotherapy and surgery vs surgery alone, was 1.28 (1.01-1.64, P = 0.05) for 1-year survival, 1.78 (1.20-2.66, P = 0.004) for 3-year survival, and 1.46 (1.07-1.99, P = 0.02) for 5-year survival. Postoperative mortality increased in patients treated by neoadjuvant chemoradiotherapy (OR: 1.68, 95% CI: 1.03-2.73, P = 0.04), but incidence of postoperative complications was similar in two groups (OR: 1.14, 95% CI: 0.88-1.49, P = 0.32). Neoadjuvant chemoradiotherapy lowered the local-regional cancer recurrence (OR: 0.64, 95% CI: 0.41-0.99, P = 0.04), but incidence of distant cancer recurrence was similar (OR: 0.94, 95% CI: 0.68-1.31, P = 0.73). Histological subgroup analysis indicated that esophageal squamous cell carcinoma did not benefit from neoadjuvant chemoradiotherapy, OR (95% CI, P value) was 1.16 (0.85-1.57, P = 0.34) for 1-year survival, 1.34 (0.98-1.82, P = 0.07) for 3-year survival and 1.41 (0.98-2.02, P = 0.06) for 5-year survival.


CONCLUSIONS
Neoadjuvant chemoradiotherapy can raise the survival rate of patients with esophageal adenocarcinoma.
Jin
Hai-Lin
HL
Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
Zhu
Hong
H
Ling
Ting-Sheng
TS
Zhang
Hong-Jie
HJ
Shi
Rui-Hua
RH
D000230:Adenocarcinoma / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D016208:Databases, Factual; D004938:Esophageal Neoplasms / Q000401:mortality / Q000628:therapy*; D006801:Humans; D020360:Neoadjuvant Therapy; D016017:Odds Ratio; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D015996:Survival Rate