Neoadjuvant Chemoradiotherapy for Esophageal Cancer: A Review of Meta-Analyses

• Published in: World journal of surgery Vol. 33; no. 12; pp. 2606 - 2614
• Main Authors: Wijnhoven, Bas P. L., van Lanschot, Jan J. B., Tilanus, Hugo W., Steyerberg, Ewout W., van der Gaast, Ate
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.12.2009; Springer‐Verlag; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adenocarcinoma - drug therapy; Adenocarcinoma - radiotherapy; Advanced Esophageal Cancer; Biological and medical sciences; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - radiotherapy; Cardiac Surgery; Chemotherapy, Adjuvant; Complete Pathological Response; Esophageal Cancer; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - radiotherapy; Esophagus; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; General Surgery; Humans; Medical sciences; Medicine; Medicine & Public Health; Meta-Analysis as Topic; Neoadjuvant Therapy; Primary Trial; Radiotherapy, Adjuvant; Randomized Controlled Trials as Topic; Significant Survival Benefit; Surgery; Thoracic Surgery; Tumors; Vascular Surgery; Esophageal Cancer; Complete Pathological Response; Significant Survival Benefit; Primary Trial; Advanced Esophageal Cancer; Medicine; Surgery; Esophageal disease; Digestive diseases; Malignant tumor; Review; Chemoradiotherapy; Esophagus cancer; Bibliographic review; Neoadjuvant treatment; Cancer; Metaanalysis
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-009-0223-z

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.