Survival After Neoadjuvant and Adjuvant Treatments Compared to Surgery Alone for Resectable Esophageal Carcinoma

Abstract

This network meta-analysis showed neoadjuvant CRT followed by surgery to be the most effective strategy in improving survival of resectable esophageal cancer. Resources should be focused on developing the most effective neoadjuvant CRT regimens for both adenocarcinomas and squamous cell carcinomas of the esophagus.

The frontline of esophageal cancer treatment: questions to be asked and answered

“…(50,51). Other smaller trials and meta-analyses for postoperative RT yielded similar results (38,40).…”

“…Pasquali et al grouped the adjuvant therapies as one group and compared with surgery alone. No significant survival advantage was noted (HR =0.87, 95% CI: 0.67-1.14) (38).…”

Oesophageal cancer

“…77 Oesophagectomy typically includes the removal of most of the oesophagus together with the cardia and lesser curve of the stomach (Figure 3). Some issues related to oesophagectomy deserve special attention.…”

Is it still time for meta-analyses in operable esophageal cancers, or rather for a change of paradigm?

“…Since the years 2000, there have been many meta-analyses, the last one published in 2011 (1). Although only two new trials on the subject have been released since that time, a tenth metaanalysis was published in March 2017, subtitled "network meta-analysis" (2). What did it add to our knowledge?…”

“…The fact is that neoadjuvant CT or RT provide few pathological complete responses (pCR), between 2% and 10% (2,8,(10)(11)(12), although neoadjuvant CRT produces between 16% and 43% pCR, usually around 30% (2,8,(13)(14)(15)(16). These 30% pCR are embedded in the 50% or more clinical complete responses (cCR) (17)(18)(19).…”