Neoadjuvant chemoradiation therapy for resectable esophago-gastric adenocarcinoma: a meta-analysis of randomized clinical trials

Abstract

BackgroundThe efficacy and safety of preoperative chemoradiation therapy (CRT) for advanced esophago-gastric adenocarcinoma are still in question, and the prognosis of these patients is poor.MethodsWe systematically searched electronic databases from January 1990 to July 2014. The primary outcome was overall survival. The secondary outcomes were a R0 resection rate, positive rate of lymph node metastasis, postoperative recurrence rate, pathological complete response (pCR) rate and perioperative mortality. Overall survival was measured with a hazard ratio (HR), while other secondary outcomes were measured with an odds ratio (OR).ResultsSeven randomized controlled trials (RCTs) including 1085 patients were searched and, of these, 869 had adenocarcinoma. Patients receiving preoperative CRT had a longer overall survival (HR 0.74; 95% confidence interval (CI) 0.63–0.88), higher likelihood of R0 resection and greater chance of pCR, while they had a lower likelihood of lymph node metastasis and postoperative recurrence. The difference of perioperative mortality was non-significant. In addition, the result of the comparison between preoperative CRT and preoperative chemotherapy (CT) in two RCTs was non-significant.ConclusionPatients with resectable esophago-gastric adenocarcinoma can gain a survival advantage from preoperative CRT. However, limited to the number of RCTs, the effect of adding radiotherapy to preoperative CT separately is still uncertain and more high-quality prospective trials are needed.

Correlation of pathological complete response with survival after neoadjuvant chemotherapy in gastric or gastroesophageal junction cancer treated with radical surgery: A meta-analysis

“…Compared with neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy usually achieves a better pCR rate[ 29 ]. However, it is difficult to determine whether the long-term outcome of patients after neoadjuvant chemoradiotherapy is better than that of neoadjuvant chemotherapy.…”

Combination of preoperative platelet/lymphocyte and neutrophil/lymphocyte rates and tumor-related factors to predict lymph node metastasis in patients with gastric cancer

“…Worldwide, neoadjuvant therapy is increasingly being advocated to treat patients with gastric cancer, showing a survival advantage compared with surgery only, without increasing postoperative morbidity and mortality 8 , 27 – 29 . The theoretical benefits of neoadjuvant therapy have been analyzed in previous studies 30 , 31 .…”

“…Recently, neoadjuvant therapy has been proposed as a new treatment standard for certain gastric cancer patients, especially for those with LN metastasis 6 , 7 . Even though controversies exist on the optimal timing and regimens of neoadjuvant therapies, the beneficial effects of this strategy, such as preoperative chemotherapy or chemoradiotherapy, have been proved in some randomized-controlled trials (RCTs) 8 – 10 . The current National Comprehensive Cancer Network guidelines have also recommended a previous option of perioperative chemotherapy or an alternate approach of preoperative chemoradiotherapy for LNs-positive patients 11 .…”

Effect of albumin-globulin score and albumin to globulin ratio on survival in patients with heart failure: a retrospective cohort study in China

“…The diagnosis of HF was based on a history of dyspnoea with symptomatic exercise intolerance, and signs of documentation of left ventricular enlargement or peripheral oedema or pulmonary congestion or radionuclide ventriculography or dysfunction by chest X-ray and/or echocardiography. 13 Informed consent was obtained from all patients prior to participation. All methods were performed in accordance with the relevant guidelines and regulations.…”