BACKGROUND: There is no general agreement on the effect of neoadjuvant treatment for esophageal cancer on patient survival. METHODS: A meta-analysis was performed to determine the effect of preoperative treatment on survival of patients with resectable esophageal cancer and the effect of preoperative treatment on patient mortality. A standard variance-based method was used to derive summary estimates of the absolute difference in both 2-year survival and treatment-related mortality. RESULTS: Eleven randomized trials involving 2311 patients were analyzed. Preoperative chemotherapy improved 2-year survival compared with surgery alone: the absolute difference was 4.4% (95% confidence interval [CI],.3%-8.5%). Marginal evidence of heterogeneity was eliminated by restricting attention to the four most recent studies, which increased the estimate to 6.3% (95% CI, 1.8%-10.7%). For combined chemoradiotherapy, the increase was 6.4% (nonsignificant; 95% CI, -1.2%-14.0%). Treatment-related mortality increased by 1.7% with neoadjuvant chemotherapy (95% CI, -.9%-4.3%) and by 3.4% with chemoradiotherapy (95% CI, -.1%-7.3%), compared with surgery alone. CONCLUSIONS: There seems to be a modest survival advantage for patients who receive neoadjuvant chemotherapy followed by surgery, as compared with surgery alone. There is an apparent increase in treatment-related mortality, mainly for patients who receive neoadjuvant chemoradiotherapy.
BACKGROUND: There is no general agreement on the effect of neoadjuvant treatment for esophageal cancer on patient survival. METHODS: A meta-analysis was performed to determine the effect of preoperative treatment on survival of patients with resectable esophageal cancer and the effect of preoperative treatment on patient mortality. A standard variance-based method was used to derive summary estimates of the absolute difference in both 2-year survival and treatment-related mortality. RESULTS: Eleven randomized trials involving 2311 patients were analyzed. Preoperative chemotherapy improved 2-year survival compared with surgery alone: the absolute difference was 4.4% (95% confidence interval [CI],.3%-8.5%). Marginal evidence of heterogeneity was eliminated by restricting attention to the four most recent studies, which increased the estimate to 6.3% (95% CI, 1.8%-10.7%). For combined chemoradiotherapy, the increase was 6.4% (nonsignificant; 95% CI, -1.2%-14.0%). Treatment-related mortality increased by 1.7% with neoadjuvant chemotherapy (95% CI, -.9%-4.3%) and by 3.4% with chemoradiotherapy (95% CI, -.1%-7.3%), compared with surgery alone. CONCLUSIONS: There seems to be a modest survival advantage for patients who receive neoadjuvant chemotherapy followed by surgery, as compared with surgery alone. There is an apparent increase in treatment-related mortality, mainly for patients who receive neoadjuvant chemoradiotherapy.
Authors: Ralf Metzger; Ute Warnecke-Eberz; Hakan Alakus; Fabian Kütting; Jan Brabender; Daniel Vallböhmer; Peter P Grimminger; Stefan P Mönig; Uta Drebber; Arnulf H Hölscher; Elfriede Bollschweiler Journal: J Gastrointest Surg Date: 2011-09-29 Impact factor: 3.452
Authors: Goran Marjanovic; Markus Schricker; Axel Walch; Axel zur Hausen; Ulrich T Hopt; Andreas Imdahl; Frank Makowiec Journal: J Gastrointest Surg Date: 2010-10-26 Impact factor: 3.452
Authors: Cuong P Duong; Helen Demitriou; Leann Weih; Anne Thompson; David Williams; Robert J S Thomas; Rodney J Hicks Journal: Eur J Nucl Med Mol Imaging Date: 2006-02-10 Impact factor: 9.236