Chemotherapy for carcinoma of the esophagus: A comparison of evidence from meta-analyses of randomized trials and of historical control studies

Bhansali, Mehul; Vaidya, JS; Bhatt, R. G.; Patil, Prachi; Badwe, Rajendra; Desai, P. B.

doi:10.1093/oxfordjournals.annonc.a010601

Cited by 76 publications

(30 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Earlier comparative (observational) studies using historical controls overestimated the benefits of chemotherapy [7], whereas individual RCTs from the 1990s failed to find a significant advantage in terms of overall survival with neoadjuvant chemotherapy. Two major randomized studies, the Intergroup 113 [8] and the Medical Research Council (MRC) [9] studies showed conflicting results-the former showing no difference and the latter showing a benefit with NACT.…”

Section: Neoadjuvant Chemotherapy Plus Surgery Versus Surgery Alonementioning

confidence: 97%

Multimodality Management of Esophageal Cancer

Keditsu

Jiwnani

Karimundackal

et al. 2013

Indian J Surg Oncol

View full text Add to dashboard Cite

Esophageal cancer is a highly lethal and aggressive disease and a major public health problem worldwide. The incidence of esophageal cancer in the western hemisphere has increased by 400 % in the past few decades (Posner et al. 2011). Surgery is the mainstay of definitive management of esophageal cancer; however, the results of surgery alone have been dismal, with survival rates of approximately 15 to 20 % at 5 years (Hingorani et al., Clin Oncol 23:696-705, 2011). The last three decades have seen growing interest in various adjuvant and neoadjuvant treatment strategies, with an aim to improve disease control and overall survival. However, due to conflicting and often contradictory results, there was controversy on the ideal treatment paradigm. Recent evidence suggests an improvement in overall survival with neoadjuvant therapy, both chemotherapy and chemoradiotherapy, over surgery. In this review we address various issues concerning multimodality management of locally advanced esophageal cancers: Does neoadjuvant therapy offer a definite benefit over surgery alone? If so, which neoadjuvant strategy? Does the survival benefit outweigh the increased treatment related toxicity/-morbidity? Finally, is neoadjuvant treatment the standard of care for locally advanced resectable esophageal cancer?

show abstract

Section: Neoadjuvant Chemotherapy Plus Surgery Versus Surgery Alonementioning

confidence: 97%

Multimodality Management of Esophageal Cancer

Keditsu

Jiwnani

Karimundackal

et al. 2013

Indian J Surg Oncol

View full text Add to dashboard Cite

show abstract

“…There does not appear to be any notable survival benefit of adjuvant chemotherapy [13] in esophageal cancer. The addition of adjuvant chemoradiotherapy (CRT) to surgery in cases of EGJ and gastric adenocarcinoma was investigated in the INT-0116 phase III trial [14]; adjuvant CRT was reported to give a survival benefit over surgery alone, but the advantage of postoperative treatment was questionable if adequate surgery was performed [15].…”

Section: Neoadjuvant Therapy: Chemotherapy Versus Chemoradiotherapymentioning

confidence: 90%

Western strategy for EGJ carcinoma

et al. 2016

View full text Add to dashboard Cite

In this paper, the epidemiological and clinicobiological behavior of esophagogastric junction (EGJ) adenocarcinoma in the West is compared and contrasted to that in the East, and an overview is provided of current therapeutic strategies employed for this type of tumor in Western countries. It is well known that multimodal treatment is the therapeutic standard in locally advanced EGJ adenocarcinoma, but whether neoadjuvant/perioperative chemotherapy (CT) or neoadjuvant chemoradiotherapy (CRT) is the optimal approach is still debated. Neoadjuvant CRT improves local control in locally advanced Siewert type I and II tumors, so it should be considered the treatment of choice. In the subset of these patients with microscopic systemic disease at diagnosis, more intensive exclusive chemotherapy protocols could be of benefit. Therefore, there is an urgent need to identify these patients before planning the treatment. For Siewert type III tumors, perioperative chemotherapy is the standard. While there is general agreement on the optimal surgical approach for Siewert types I and III (a two-field Ivor Lewis operation and a total gastrectomy with distal esophagectomy, respectively), no standard surgical treatment has been defined for Siewert type II tumors. When data from Western series on proximal and circumferential resection margins and on nodal spread in Siewert type II tumors are taken into account, the optimal surgical approach appears to be Ivor Lewis esophagectomy. Whether the extent of esophageal invasion can correctly predict nodal involvement in middle-upper mediastinal stations as a means to restrict indications for transthoracic esophagectomy requires further investigation in the West.

show abstract

“…Adjuvant therapy may be difficult in this disease. A recent meta-analysis by Bhansali et al (1996) of 12 randomized clinical trials and eight with historical controls revealed no significant survival benefit from cisplatin-based adjuvant/ neoadjuvant chemotherapy in oesophageal cancer.…”

Section: Concomitant Chemotherapy In the Preoperative Settingmentioning

confidence: 99%