Neoadjuvant or adjuvant therapy for resectable esophageal cancer: a systematic review and meta-analysis

Abstract

BackgroundCarcinoma of the esophagus is an aggressive malignancy with an increasing incidence. Its virulence, in terms of symptoms and mortality, justifies a continued search for optimal therapy. The large and growing number of patients affected, the high mortality rates, the worldwide geographic variation in practice, and the large body of good quality research warrants a systematic review with meta-analysis.MethodsA systematic review and meta-analysis investigating the impact of neoadjuvant or adjuvant therapy on resectable thoracic esophageal cancer to inform evidence-based practice was produced.MEDLINE, CANCERLIT, Cochrane Library, EMBASE, and abstracts from the American Society of Clinical Oncology and the American Society for Therapeutic Radiology and Oncology were searched for trial reports.Included were randomized trials or meta-analyses of neoadjuvant or adjuvant treatments compared with surgery alone or other treatments in patients with resectable thoracic esophageal cancer. Outcomes of interest were survival, adverse effects, and quality of life. Either one- or three-year mortality data were pooled and reported as relative risk ratios.ResultsThirty-four randomized controlled trials and six meta-analyses were obtained and grouped into 13 basic treatment approaches.Single randomized controlled trials detected no differences in mortality between treatments for the following comparisons:- Preoperative radiotherapy versus postoperative radiotherapy.- Preoperative and postoperative radiotherapy versus postoperative radiotherapy. Preoperative and postoperative radiotherapy was associated with a significantly higher mortality rate.- Postoperative chemotherapy versus postoperative radiotherapy.- Postoperative radiotherapy versus postoperative radiotherapy plus protein-bound polysaccharide versus chemoradiation versus chemoradiation plus protein-bound polysaccharide.Pooling one-year mortality detected no statistically significant differences in mortality between treatments for the following comparisons:- Preoperative radiotherapy compared with surgery alone (five randomized trials).- Postoperative radiotherapy compared with surgery alone (five randomized trials).- Preoperative chemotherapy versus surgery alone (six randomized trials).- Preoperative and postoperative chemotherapy versus surgery alone (two randomized trials).- Preoperative chemoradiation therapy versus surgery alone (six randomized trials).Single randomized controlled trials detected differences in mortality between treatments for the following comparison:- Preoperative hyperthermia and chemoradiotherapy versus preoperative chemoradiotherapy in favour of hyperthermia.Pooling three-year mortality detected no statistically significant difference in mortality between treatments for the following comparison:- Postoperative chemotherapy compared with surgery alone (two randomized trials).Pooling three-year mortality detected statistically significant differences between treatments for the following comparisons:- Preoperative chemoradiation therapy vers...

International comparison of the German evidence-based S3-guidelines on the diagnosis and multimodal treatment of early and locally advanced gastric cancer, including adenocarcinoma of the lower esophagus

“…One further study showed a nonsignificant trend in favor of neoadjuvant RCT. Several previous meta-analyses [49][50][51][52] confirmed these results for adenocarcinoma. The metaanalysis by Gebski demonstrated a statistically significant survival benefit for both neoadjuvant chemotherapy and neoadjuvant RCT [40].…”

Radical Esophagectomy After Neoadjuvant Chemoradiation: Single Institutional Experience from Tertiary Cancer Centre in India

“…Further milestone in the evolution of esophageal cancer management was laid by the studies showing decreasing morbidity and mortality due to the advances in patient selection, perioperative and postoperative care [18]. CROSS trial revealed pCR rate of 29 % and a low inhospital mortality of 4 %, however increased overall survival, especially in squamous cell carcinoma [12].…”

“…Treatment protocol included initial assessment by UGI Endoscopy & Biopsy for tissue diagnosis and disease staging by CECT Chest and Abdomen or Whole Body FDG 18 PET CT. Most patients with clinical stage T2/N2 or above underwent preoperative therapy (Group A; n=66) concurrent chemoradiation or preoperative chemotherapy.…”

“…All patient tolerated the treatment well with Grade 3 or 4 toxicity in 6 % patients only. Disease response assessment was done at six weeks of completion of therapy with Whole body FDG 18 PET CT followed by Radical Esophagectomy there after. Seven patients received preoperative chemotherapy only for locally advanced GE Junction adenocarcinoma with three weekly cisplatinium based chemotherapy.…”

Aspectos atuais da terapêutica neo-adjuvante no carcinoma epidermóide do esôfago: revisão da literatura

“…Malthaner et al 19 em 2004 por meio de metanálise no Canadá avaliaram 34 trabalhos randomizados e seis metanálises envolvendo 13 diferentes combinações de tratamento neo-adjuvante e/ou adjuvante na neoplasia de esôfago ressecável e concluíram que o tratamento cirúrgico isolado (ou seja, sem terapêutica neo-adjuvante ou adjuvante) deve ser recomendado como o padrão de tratamento no câncer de esôfago torácico ressecável.…”