The Comparison of the Advantages of Neoadjuvant Chemoradiotherapy versus Postoperative Chemoradiotherapy: Outcomes in Esophageal Cancer Patients

Sadrizadeh, Ali; Bagheri, Reza; Soltani, Ehsan; Anvari, Kazem; Toussi, Mehdi Seilanian; Moadikhah, Soheila

doi:10.1007/s12029-016-9899-0

Cited by 6 publications

(9 citation statements)

References 31 publications

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“…However, POCRT was associated with a higher risk of postoperative complications [46]. In the current study, adjuvant chemotherapy was administered to 85.7% and 75.8% in ENI and IFI groups, respectively; the numbers of chemotherapy cycles were higher in ENI group than that of IFI group (3.1 vs. 2.4); this also could explain the higher incidence of toxicities in the former.…”

Section: Discussionmentioning

confidence: 62%

Adjuvant Radiotherapy of Involved Field versus Elective Lymph Node in Patients with Operable Esophageal Squamous Cell Cancer: A Single Institution Prospective Randomized Controlled Study

Liu

Zhang

et al. 2021

J. Cancer

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Background: To evaluate locoregional failure and its impact on survival by comparing involved field irradiation (IFI) with elective lymph node irradiation (ENI) for patients with esophageal squamous cell cancer who underwent post-operative radiotherapy. Methods and Materials: The enrolled patients were randomized allocated to IFI or ENI group. CTV of IFI was generated according to pre-operative primary tumor location and post-operative pathological characters and positive LNs regions. CTV of ENI was generated according to pre-operative tumor position to administer selective lymph node irradiation. Radiotherapy planning was delivered using either 3D-CRT or IMRT. Results: A total of 57 patients were enrolled, 28 patients in ENI group and 29 patients in IFI group. There were not statistical differences between two groups in baseline (p>0.05). The initial locoregional failure rate was 17.9 % in ENI arm and 20.7% in IFI arm respectively (p=0.085). The 1-, 3-, and 5-year Progression-free Survival (PFS) were 63.2, 43.5, and 21.8 % in ENI arm versus 78.2, 60.1, and 55.1% in IFI arm (p =0.038). The 1-, 3-, and 5-year overall survival (OS) were 78.6, 46.9, and 23.5 % in ENI arm versus 72.9, 59.7, and 54.3 % in IFI arm (p=0.06). Acute radiation pneumonitis (p=0.005) and hematological toxicities (p =0.029) also showed statistical differences between groups, ENI arm was more than IFI arm. Conclusions: The results indicated that IFI tended to improve survival and reduce toxicities for patients with operative ESCC and did not increase locoregional failure compared to ENI. It is thus suggested that IFI for ESCC PORT is worthy of clinical recommendation and further study.

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Section: Discussionmentioning

confidence: 62%

Adjuvant Radiotherapy of Involved Field versus Elective Lymph Node in Patients with Operable Esophageal Squamous Cell Cancer: A Single Institution Prospective Randomized Controlled Study

Liu

Zhang

et al. 2021

J. Cancer

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“…Twenty RCTs [6,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] indirectly compared neoadjuvant therapy and surgery alone, and five RCTs [20][21][22][23][24][25] indirectly compared adjuvant therapy and surgery alone. Among six studies [9,10,[45][46][47][48] that directly compared neoadjuvant therapy with adjuvant therapy, one [10] was RCT and five [9,[45][46][47][48] were retrospective controlled studies. One study [22] was a three-arm RCT with both direct and indirect comparisons.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

The Efficacy of Neoadjuvant Versus Adjuvant Therapy for Resectable Esophageal Cancer Patients: A Systematic Review and Meta‐Analysis

Xiao

Hong

Zeng³

et al. 2020

World j. surg.

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Objective Inconclusive results are available as to whether chemo/radiotherapy should be administered to resectable esophageal cancer patients before surgery (neoadjuvant therapy) or after surgery (adjuvant therapy). The paper, via a meta-analysis of effects of treatment modalities when administering chemo/radiotherapy, aims to systematically evaluate the effect of timing of chemo/radiotherapy and surgery. Methods We performed a systematic literature search for clinical trials of neoadjuvant and adjuvant therapy for patients with esophageal cancer. Using meta-analysis, we conducted direct and adjusted indirect comparisons of overall survival, complete resection rate (R0 resection), perioperative mortality, leakage rate and local recurrence in patients with resectable esophageal cancer. Results A total of 32 studies involving 7985 patients with esophageal cancer were included in the meta-analysis. Twenty-five randomized controlled studies indirectly compared neoadjuvant/adjuvant therapy with surgery alone, while five non-randomized controlled studies and two randomized controlled studies directly compared neoadjuvant with adjuvant therapy. Neoadjuvant therapy followed by surgery, compared with surgery along with adjuvant therapy, showed a significant overall survival advantage in our pooled analysis (HR 0.88; 95% CI 0.79-0.98). Directly compared with adjuvant therapy, neoadjuvant therapy demonstrated a lower local recurrence rate (OR 0.56; 95% CI 0.43-0.74) with low heterogeneity (I 2 = 1%). Neoadjuvant therapy, comparing to surgery with or without adjuvant therapy, showed a significantly higher R0 resection rate (OR 2.86; 95% CI 2.02-4.04) with moderate heterogeneity (I 2 = 38%) and no significant differences in postoperative anastomotic leakage (P = 0.50). However, neoadjuvant therapy, compared with surgery adjuvant therapy, significantly increased perioperative mortality in both direct and indirect comparisons (P \ 0.01). Conclusions We found that neoadjuvant therapy was associated with higher overall survival and R0 resection rate without increasing postoperative anastomotic leakage for patients with resectable esophageal cancer, whereas neoadjuvant therapy was associated with higher perioperative mortality after esophagectomy.Xin Xiao and Hyokyoung G. Hong are joint first authors.

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“…Two prospective RCTs 15,32 and six retrospective control studies [33][34][35][36][37][38] compared S+CRT with CRT+S directly. Their characteristics are presented in Table 3.…”

Section: S+crt Versus Neoadjuvant Chemoradiotherapy Followed By Surgementioning

confidence: 99%

“…Most studies were conducted in Asian countries, including three in China, 15,32,36 one in Taiwan 37 and one in Iran. 38 Most retrospective studies [33][34][35][36][37][38] and published RCTs 15 suggested that there were no significant differences in OS between CRT+S and S+CRT. However, most studies showed a trend toward survival benefits in the CRT+S group, except for one study.…”

Section: S+crt Versus Neoadjuvant Chemoradiotherapy Followed By Surgementioning

confidence: 99%

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<p>Postoperative Radiotherapy for Thoracic Esophageal Carcinoma with Upfront R0 Esophagectomy</p>

Wang

2020

CMAR

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Multidisciplinary therapies can improve the survival of patients with locally advanced esophageal carcinoma. However, the determination of the optimal modality is still a controversial subject. Many randomized controlled trials in the late 20th century showed that there was no survival benefit when postoperative radiotherapy was added to surgery for esophageal carcinoma. As a result, the treatment modality shifted thereafter to neoadjuvant therapies. Even so, these trials are criticized for many limitations and an increasing number of studies (mainly nonrandomized controlled trials) has indicated that postoperative radiotherapy/chemoradiotherapy can improve the survival of patients with a poor prognosis after R0 esophagectomy. Additionally, a large number of patients with locally advanced esophageal carcinoma still choose upfront surgery in the clinical practice due to many reasons. Therefore, postoperative radiotherapy seems to be a feasible treatment for these patients with a poor prognosis, particularly in the new era of conformal radiotherapy. Here, we review published studies on postoperative radiotherapy/chemoradiotherapy, and we discuss the clinical issues related to postoperative radiotherapy, such as the indication, target volume, total radiation dosage, time interval and complications of postoperative radiotherapy with or without chemotherapy, to make recommendations of postoperative radiotherapy for both current practice and future research in esophageal carcinoma.

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The Comparison of the Advantages of Neoadjuvant Chemoradiotherapy versus Postoperative Chemoradiotherapy: Outcomes in Esophageal Cancer Patients

Abstract: No conclusion can be drawn on whether there are any advantages in adjuvant chemoradiotherapy over neoadjuvant approaches. Further confirmatory trials, particularly randomized trials, are necessary before any recommendations can be made.

Cited by 6 publications

References 31 publications

Adjuvant Radiotherapy of Involved Field versus Elective Lymph Node in Patients with Operable Esophageal Squamous Cell Cancer: A Single Institution Prospective Randomized Controlled Study

Adjuvant Radiotherapy of Involved Field versus Elective Lymph Node in Patients with Operable Esophageal Squamous Cell Cancer: A Single Institution Prospective Randomized Controlled Study

The Efficacy of Neoadjuvant Versus Adjuvant Therapy for Resectable Esophageal Cancer Patients: A Systematic Review and Meta‐Analysis

<p>Postoperative Radiotherapy for Thoracic Esophageal Carcinoma with Upfront R0 Esophagectomy</p>

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