Effect of neoadjuvant chemoradiotherapy on prognosis and surgery for esophageal carcinoma

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

Terapêutica neo-adjuvante aumenta as complicações pós-operatórias da esofagectomia?

“…Alguns trabalhos avaliando o tratamento neo-adjuvante foram publicados com resultados controversos especialmente em relação à possível melhora da sobrevida as custas de maiores complicações peri-operatórias 1,2,4,8,11,14,15,16,17,18,19,21,22,28,35,36,38,40 .…”

Utility of preoperative chemoradiotherapy for advanced esophageal carcinoma

“…[33][34][35][36][37][38] These cells are characterized by: (i) resistance to anticancer drugs; (ii) high proliferative activity; (iii) high tumorigenicity with a small number of cells; and (iv) expression of several genes specific for stem cells in the normal tissue. Elucidation of the presence of similar cells in esophageal cancer will enable in vitro evaluation of response to chemotherapy with anticancer drugs and irradiation of these cells, and greatly contribute to an improvement in prognosis as a step-up in treatment selection.…”

Early evaluation of the apoptotic index ratio is useful in predicting the efficacy of chemoradiotherapy in esophageal squamous cell carcinoma

“…Despite recent advances in multimodality treatment, complete pathological response to chemoradiotherapy occurred in 10-45.5% of patients with advanced esophageal cancer (5). Patients with advanced esophageal cancer are not likely to reap any benefits from chemoradiotherapy.…”