title: Systematic review and network meta-analysis: neoadjuvant chemoradiotherapy for locoregional esophageal cancer.
abstract: OBJECTIVE
  Neoadjuvant chemoradiotherapy improves survival in patients with locoregional esophageal cancer. This study compares the efficacy of two common regimens, paclitaxel plus platinum and platinum plus 5-fluorouracil, based on overall survival.
  
  
  METHODS
  We performed a systematic review and network meta-analysis of randomized trials comparing paclitaxel plus platinum-neoadjuvant chemoradiotherapy or and platinum plus 5-fluorouracil-neoadjuvant chemoradiotherapy with surgery alone. The outcome was the hazard ratios for death in the entire population and the two major histologic subgroups, squamous cell carcinoma and adenocarcinoma.
  
  
  RESULTS
  Ten clinical trials were included. Compared with surgery alone, the hazard ratios [95% credible interval (CrI)] in the entire, squamous cell carcinoma, and adenocarcinoma population were 0.63 (0.50-0.80), 0.50 (0.36-0.71) and 0.74 (0.54-1.01) for paclitaxel plus platinum, and 0.79 (0.68-0.92), 0.82 (0.67-1.01) and 0.81 (0.63-1.05) for platinum plus 5-fluorouracil, respectively. When paclitaxel plus platinum was compared with platinum plus 5-fluorouracil, the hazard ratios (95% CrI) in the entire, squamous cell carcinoma, and adenocarcinoma population were 0.80 (0.60-1.06), 0.61 (0.41-0.91) and 0.91 (0.61-1.36), respectively. The probability of paclitaxel plus platinum being ranked the optimal treatment for the entire, squamous cell carcinoma, and adenocarcinoma population was 94.2, 99.1 and 67.6%, respectively.
  
  
  CONCLUSIONS
  Neoadjuvant chemoradiotherapy with paclitaxel plus platinum regimen seemed to be a better treatment than platinum plus 5-fluorouracil regimen for locoregional esophageal cancer, especially for squamous cell carcinoma.
authors.affiliation: Department of Oncology, National Taiwan University Hospital, Taipei City Graduate Institute of Oncology, National Taiwan University, College of Medicine, Taipei City.
authors.forename: Ta-Chen
authors.initials: TC
authors.lastname: Huang
authors.affiliation: Department of Oncology, National Taiwan University Hospital, Taipei City Graduate Institute of Oncology, National Taiwan University, College of Medicine, Taipei City.
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Hsu
authors.affiliation: Department of Oncology, National Taiwan University Hospital, Taipei City Graduate Institute of Oncology, National Taiwan University, College of Medicine, Taipei City.
authors.forename: Chia-Chi
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan yukangtu@ntu.edu.tw.
authors.forename: Yu-Kang
authors.initials: YK
authors.lastname: Tu
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D020360:Neoadjuvant Therapy / Q000379:methods*; D017239:Paclitaxel / Q000008:administration & dosage; D017671:Platinum Compounds / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D017671:Platinum Compounds; D017239:Paclitaxel; D005472:Fluorouracil
keywords: chemoradiation; esophageal cancer; neoadjuvant therapy; paclitaxel