Meta-analysis of postoperative efficacy in patients receiving chemoradiotherapy followed by surgery for resectable esophageal carcinoma

Abstract

BackgroundMany studies have demonstrated that chemoradiotherapy followed by surgery (CRTS) prolongs the 5-year survival rate of resectable esophageal carcinoma patients. However, the effect of CRTS on postoperative complications, local recurrence and distant metastasis remains controversial. We performed a systematic review of the literature and conducted a meta-analysis to assess the postoperative efficacy of CRTS compared with surgery alone (SA).MethodsPubmed, Web of Science and the Cochrane library Databases were used to identify published studies between 2000 and 2013 that directly compared CRTS with SA. The pooled relative risk (RR) and its corresponding 95% confidence interval (95% CI) constituted the principal measure of treatment effects. Heterogeneity was assessed by the χ2 and I2 statistic.ResultsThe final analysis included 1930 resectable esophageal carcinoma cases from 13 randomized controlled trials (RCTs). Compared with SA, CRTS was associated with significantly decreased postoperative mortality, local recurrence and distant metastasis rates, with RR (95% CI) = 0.64 (0.49–0.84), 0.53 (0.39–0.73), 0.82 (0.68–0.98); p = 0.001, <0.00001, =0.03, respectively. However, there was no significant difference in postoperative complication incidence between the two groups (RR, 1.09; 95% CI, 0.96–1.24; p = 0.18).ConclusionsCRTS significantly decreased postoperative mortality, local recurrence and distant metastasis rates compared to SA. Additionally, there were no increased postoperative complications for patients with resectable esophageal carcinoma.Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1531519216130950

Preoperative therapy in locally advanced esophageal cancer

“…Another meta-analysis which included 13 RCTs ( n = 1930, resectable esophageal cancers) addressed the issue of postoperative complications following preoperative CRT compared to surgery alone[ 45 ]. The authors reported that preoperative CRT did not lead to significantly higher postoperative complications compared to surgery alone (RR = 1.09, 95%CI: 0.96-1.24, P = 0.18) (Figure 3 ); indeed, preoperative CRT led to reduction in postoperative mortality (RR = 0.64, 95%CI: 0.49-0.84, P = 0.001).…”

“… The forest plots of postoperative mortality and complications of chemoradiotherapy followed by surgery vs surgery alone using a fixed effects model (Reproduced from Deng et al[ 45 ]). …”

Combined Modality Therapy for Thoracic and head and Neck Cancers: A Review of Updated Literature Based on a Consensus Meeting

“…To further investigate the value of the trimodal approach vs surgery alone, several meta-analyses were performed. With differences in the endpoint analyzed and background of the evaluated studies, few of them revealed only a nonsignificant trend in favor of RT-CT, while most of them showed a significant benefit (70)(71)(72)(73)(74)(75)(76)(77). If the role of preoperative RT-CT over surgery alone seems well-established, its benefit over preoperative CT alone seems more controversial.…”

Detection of LINE-1 hypomethylation in cfDNA of Esophageal Adenocarcinoma Patients

“…Esophageal adenocarcinoma (EADC) is a highly lethal malignancy [1][2][3], the incidence of which is continually increasing in Western countries [4,5]. Unfortunately, despite implementation of the latest therapeutic approaches, patient outcomes remain generally unfavorable [2], and no indicators that allow monitoring of the duration of therapy response or early detection of recurrence are available yet.…”