Neoadjuvant chemotherapy and surgery versus surgery alone in resectable esophageal cancer

Bushan, Kirti; Sharma, SK

doi:10.4103/0019-509x.176743

Cited by 3 publications

(2 citation statements)

References 4 publications

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“…Surgery remains the mainstay for ESCC or EAC, but surgery alone did not show satisfactory clinical data. Some studies showed that neoadjuvant therapy was the most effective strategy in improving survival of resectable esophageal cancer ( 2 , 3 ). At present, the neoadjuvant therapy is widely applied to improve long-term survival rate in clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Comparison of neoadjuvant immunotherapy versus routine neoadjuvant therapy for patients with locally advanced esophageal cancer: A systematic review and meta-analysis

et al. 2023

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BackgroundThe neoadjuvant use of immune checkpoint inhibitor combined with chemotherapy (nICT) or chemoradiotherapy (nICRT) in locally advanced esophageal cancer (EC) is currently an area of active ongoing research. Therefore, we carried out a comprehensive meta-analysis to compare the efficacy and safety of the new strategy with routine neoadjuvant strategy, which included neoadjuvant chemotherapy (nCT) and neoadjuvant chemoradiotherapy (nCRT).Patients and methodsMEDLINE (via PubMed), Embase (via OVID), ISI Web of Science database and Cochrane Library were included. And, all of them were searched for eligible studies between January, 2000 and February, 2023. The pathological complete response (pCR) and major pathological response (MPR) were primary outcome of our study. The second outcome of interest was R0 resection rate. Odds ratio (OR) and associated 95% CI were used as the effect indicators comparing the safety and efficiency of the neoadjuvant immunotherapy with the routine neoadjuvant therapy. Fixed-effect model (Inverse Variance) or random-effect model (Mantel-Haenszel method) was performed depending on the statistically heterogeneity.ResultsThere were eight trials with 652 patients were included in our meta-analysis. The estimated pCR rate was higher in the neoadjuvant immunotherapy group (OR =1.86; 95% CI, 1.25–2.75; I2 = 32.8%, P=0.166). The different results were found in the esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) subgroups, the estimated OR was 2.35 (95%CI, 1.00–2.72; I2 = 30.9%, P=0.215) in the EAC subgroup, and 2.35 (95% CI, 1.20–4.54; I2 = 45.3%, P=0.161) in the ESCC subgroup, respectively. The neoadjuvant immunotherapy also showed the advantage in the MPR rates (OR =2.66; 95% CI, 1.69–4.19; I2 = 24.3%, P=0.252). There was no obvious difference between the neoadjuvant immunotherapy and routine neoadjuvant therapy with respect to surgical resection rate, R0 resection rate, surgical delay rate; while more treatment-related adverse events were observed for the neoadjuvant immunotherapy for pneumonitis/pneumonia (OR=3.46, 95% CI, 1.31–9.16; I2 = 67.3%, P=0.005) and thyroid dysfunction (OR=4.69, 95% CI, 1.53–14.36; I2 = 56.5%, P=0.032).ConclusionThe pooled correlations indicated that the neoadjuvant immunotherapy (both nICT and nICRT) could significantly increase the rates of pCR and MPR, compared with routine neoadjuvant therapy (both nCT and nCRT) in the treatment of locally advanced EC. The neoadjuvant immunotherapy and routine neoadjuvant therapy were with acceptable toxicity. However, randomized studies with larger groups of patients need to performed to confirm these results.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42020155802.

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Section: Introductionmentioning

confidence: 99%

Comparison of neoadjuvant immunotherapy versus routine neoadjuvant therapy for patients with locally advanced esophageal cancer: A systematic review and meta-analysis

et al. 2023

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“…However, relying solely on surgery has not yielded satisfactory clinical outcomes. Several studies have demonstrated that neoadjuvant therapy offers an effective strategy for improving survival in patients with resectable EC 6 , 7 . Currently, neoadjuvant therapy primarily consists of neoadjuvant chemotherapy (NCT) and neoadjuvant chemoradiotherapy (NCRT).…”

Section: Introductionmentioning

confidence: 99%

Comparison of efficacy and safety between neoadjuvant chemotherapy and neoadjuvant immune checkpoint inhibitors combined with chemotherapy for locally advanced esophageal squamous cell carcinoma: a systematic review and meta-analysis

Xu,

Cai,

Hong

et al. 2023

International Journal of Surgery

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Background: The application of neoadjuvant immune checkpoint inhibitors combined with chemotherapy(NICT) in treating locally advanced esophageal squamous cell carcinoma (ESCC) is a subject of considerable research interest. In light of this, we undertook a comprehensive meta-analysis aiming to compare the efficacy and safety of this novel approach with conventional neoadjuvant chemotherapy (NCT) in the management of ESCC. Methods: A systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science to gather relevant literature on the efficacy and safety of NICT compared to conventional NCT in locally advanced ESCC published before June 2023. Effect indicators, including odds ratios (ORs) with associated 95% confidence intervals (CIs), were employed to evaluate the safety and efficacy outcomes. The risk of bias was assessed using the Cochrane bias risk assessment tool, and subgroup analysis and sensitivity analysis were conducted to investigate the findings further. Results: A total of 9 studies qualified for the meta-analysis, all of which investigated the efficacy and safety of NICT compared to conventional NCT. The pooled rates of pathologic complete response (pCR) and major pathologic response (MPR) in the NICT group were significantly higher compared to the NCT group, with values of 26.9% versus 8.3% (P＜0.00001) and 48.1% versus 24.6% (P＜0.00001), respectively. The ORs for achieving pCR and MPR were 4.24 (95% CI, 2.84–6.32, I2=14%) and 3.30 (95% CI, 2.31–4.71, I2=0%), respectively, indicating a significant advantage for the NICT group. Regarding safety outcomes, the pooled incidences of treatment-related adverse events (TRAEs) and serious adverse events (SAEs) in the NICT group were 64.4% and 11.5%, respectively, compared to 73.8% and 9.3% in the NCT group. However, there were no significant differences observed between the two groups in terms of TRAEs (OR=0.67, 95% CI, 0.29–1.54, P=0.35, I2 =58%) or SAEs (OR=1.28, 95% CI, 0.69–2.36, P=0.43, I2=0%). Furthermore, no significant differences were found between the NICT and NCT groups regarding R0 resection rates, anastomotic leakage, pulmonary infection, and postoperative hoarseness. Conclusions: Neoadjuvant immune checkpoint inhibitors combined with chemotherapy demonstrate efficacy and safety in treating resectable esophageal squamous cell carcinoma. Nevertheless, additional randomized trials are required to confirm the optimal treatment regimen.

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Neoadjuvant therapy or upfront surgery? A systematic review and meta-analysis of T2N0 esophageal cancer treatment options

Mota

Cecconello

Takeda

et al. 2018

International Journal of Surgery

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Neoadjuvant chemotherapy and surgery versus surgery alone in resectable esophageal cancer

Cited by 3 publications

References 4 publications

Comparison of neoadjuvant immunotherapy versus routine neoadjuvant therapy for patients with locally advanced esophageal cancer: A systematic review and meta-analysis

Comparison of neoadjuvant immunotherapy versus routine neoadjuvant therapy for patients with locally advanced esophageal cancer: A systematic review and meta-analysis

Comparison of efficacy and safety between neoadjuvant chemotherapy and neoadjuvant immune checkpoint inhibitors combined with chemotherapy for locally advanced esophageal squamous cell carcinoma: a systematic review and meta-analysis

Neoadjuvant therapy or upfront surgery? A systematic review and meta-analysis of T2N0 esophageal cancer treatment options

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