Brief Article
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Oct 21, 2009; 15(39): 4962-4968
Published online Oct 21, 2009. doi: 10.3748/wjg.15.4962
Effect of neoadjuvant chemoradiotherapy on prognosis and surgery for esophageal carcinoma
Jin Lv, Xiu-Feng Cao, Bin Zhu, Lv Ji, Lei Tao, Dong-Dong Wang
Jin Lv, Xiu-Feng Cao, Bin Zhu, Lv Ji, Lei Tao, Dong-Dong Wang, Oncology Center, Department of Surgery, Affiliated Nanjing First Hospital of Nanjing Medical University and Oncology Center of Nanjing Medical University, Nanjing 210006, Jiangsu Province, China
Author contributions: Lv J participated in the design of study, analysis and interpretation of data, manuscript writing and statistical analysis of data, revision of the manuscript; Cao XF substantially contributed to the conception and design of study, fund acquisition, administration and materials support; Zhu B, Ji L, Tao L and Wang DD provided supportive contributions.
Correspondence to: Xiu-Feng Cao, Professor, Oncology Center, Department of Surgery, Affiliated Nanjing First Hospital of Nanjing Medical University and Oncology Center of Nanjing Medical University, 68 Changle Road, Nanjing 210006, Jiangsu Province, China. cxf551101@sina.com
Telephone: +86-25-52887061 Fax: +86-25-52269924
Received: August 1, 2009
Revised: September 1, 2009
Accepted: September 8, 2009
Published online: October 21, 2009
Abstract

AIM: To investigate the role of neoadjuvant chemoradiotherapy in prognosis and surgery for esophageal carcinoma by a meta-analysis.

METHODS: PubMed and manual searches were done to identify all published randomized controlled trials (RCTs) that compared neoadjuvant chemoradiotherapy plus surgery (CRTS) with surgery alone (S) for esophageal cancer. According to the test of heterogeneity, a fixed-effect model or a random effect model was used and the odds ratio (OR) was the principal measure of effects.

RESULTS: Fourteen RCTs that included 1737 patients were selected with quality assessment ranging from A to C (Cochrane Reviewers’ Handbook 4.2.2). OR (95% CI, P value), expressed as CRTS vs S (values > 1 favor CRTS arm), was 1.19 (0.94-1.48, P = 0.28) for 1-year survival, 1.33 (1.07-1.65, P = 0.69) for 2-year survival, 1.76 (1.42-2.19, P = 0.11) for 3-year survival, 1.41 (1.06-1.87, P = 0.11) for 4-year survival, 1.64 (1.28-2.12, P = 0.40) for 5-year survival, 0.82 (0.39-1.73, P < 0.0001) for rate of resection, 1.53 (1.33-2.84, P = 0.007) for rate of complete resection, 1.78 (1.14-2.78, P = 0.79) for operative mortality, 1.12 (0.89-2.48, P = 0.503) for all treatment mortality, 1.33 (0.94-1.88, P = 0.04) for the rate of adverse treatment, 1.38 (1.23-1.63, P = 0.0002) for local-regional cancer recurrence, 1.28 (0.85-1.58, P = 0.60) for distant cancer recurrence, and 1.27 (0.86-1.65, P = 0.19) for all cancer recurrence. A complete pathological response to chemoradiotherapy occurred in 10%-45.5% of patients. The 5-year survival benefit was most pronounced when chemotherapy and radiotherapy were given concurrently (OR: 1.45, 95% CI: 1.26-1.79, P = 0.015) instead of sequentially (OR: 0.85, 95% CI: 0.64-1.35, P = 0.26).

CONCLUSION: Compared with surgery alone, neoadjuvant chemoradiotherapy can improve the long-term survival and reduce local-regional cancer recurrence. Concurrent administration of neoadjuvant chemoradiotherapy was superior to sequential chemoradiotherapy.

Keywords: Esophageal neoplasms/surgery; Esophageal neoplasms/radiotherapy; Antineoplastic agents; Postoperative complications; Prospective studies; Randomized controlled trial; Meta-analysis