Comparison of the prognosis of neoadjuvant chemoradiotherapy treatment with surgery alone in esophageal carcinoma: a meta-analysis
Authors Ma HF, Lv GX, Cai ZF, Zhang DH
Received 28 June 2017
Accepted for publication 29 September 2017
Published 14 June 2018 Volume 2018:11 Pages 3441—3447
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr Jianmin Xu
Hai-Feng Ma, Guo-Xiao Lv, Zhong-Fang Cai, Da-Hai Zhang
Department of Radiotherapy, Dongyang People’s Hospital, Dongyang, Zhejiang, China
Background: Resection remains the best treatment for carcinoma of the esophagus in terms of local control, but local recurrence and distant metastasis remain an issue after surgery. Chemoradiotherapy (CRT) followed by surgery was associated with significantly improved survival benefit, but the effectiveness of neoadjuvant therapy in patients with resectable esophageal carcinoma remains controversial. The aim of this study was to evaluate the effects of neoadjuvant chemoradiotherapy in resectable esophageal carcinoma compared to surgery alone (SA).
Methods: A search for publications that compared the efficacy of CRT with SA in resectable esophageal carcinoma was conducted. After a rigorous review of the quality, the data were extracted from eligible trials. The major outcomes measures were odds ratios (ORs). The ORs with their corresponding 95% confidence intervals were the principal measure of effects. For the meta-analysis, Revman 5.3 software was used to analyze the combined pooled ORs using fixed- or random-effects models according to the heterogeneity.
Results: Our findings revealed that, compared with SA, neoadjuvant CRT was associated with improved overall survival (OS) and progression-free survival times, but the 3- and 5-year OS did not show a statistical difference (P≥0.05). The adjuvant chemotherapy group did not show significant improvement on reference rate and metastasis rate compared with the control group.
Conclusion: CRT does significantly improve progression-free survival and OS in patients with esophageal cancer compared with SA. However, further assessment is still warranted on the role of CRT in future trials with well-selected patients.
Keywords: esophageal cancer, surgery, chemoradiation, neoadjuvant therapy
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