Survival and complications after neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy for esophageal squamous cell cancer: A meta-analysis

Guo, Yaru; Xu, Mingna; Lou, Yufei; Yuan, Yan; Wu, Yuling; Zhang, Longzhen; Xin, Yong; Zhou, Fengjuan

doi:10.1371/journal.pone.0271242

Cited by 4 publications

(3 citation statements)

References 41 publications

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“…Guo et al ‘s meta-analysis found that nCRT could prolong survival, but the reliability of its conclusions was low due to the large number of retrospective studies included in this meta-analysis. [11] Another network meta-analysis by Kelvin et al found that in the direct comparison between nCRT and nCT, there was no significant statistical difference in OS, but indirect comparison showed the opposite result. [10] Our meta-analysis focused only on randomized controlled trials that compared head-to-head nCRT to nCT, and updated recent studies.…”

Section: Discussionmentioning

confidence: 99%

“…Due to insufficient data provided by previous randomized trials, some previous meta-analyses included cohort studies, leading to low levels of evidence, unreliable conclusions and some major defects. [11] Moreover, meta-analyses of randomized trials do not support survival benefits of nCRT [12][13][14] ]. So far, the jury is still out on whether to add additional radiation therapy.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy in locally advanced esophageal cancer: An updated meta-analysis

Liang,

Chen,

et al. 2024

Medicine

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Background: Currently, the optimal treatment for neoadjuvant therapy for locally advanced esophageal cancer is not clear, and there is no evidence that neoadjuvant chemoradiotherapy (nCRT) is superior to neoadjuvant chemotherapy (nCT). Due to the publication of new clinical trials and defects in previous meta-analyses, we conducted an updated meta-analysis to evaluate the efficacy and safety of nCRT and nCT. Methods: The following databases were searched for studies: PubMed, EMBASE, and Cochrane library (updated to April 22, 2023). All randomized trials comparing nCRT with nCT in locally advanced esophageal cancer met the inclusion criteria. Data were analyzed using Review Manager 5.4.1 (Cochrane collaboration software). Primary outcomes assessed from the trials included overall survival (OS), progression-free survival (PFS), pathological complete response (pCR), R0 resection rate, postoperative complications, postoperative mortality, and grade 3 or higher adverse events (3 + AEs). Results: This systematic review and meta-analysis included 7 randomized controlled studies involving 1372 patients (686 receiving nCRT and 686 receiving nCT). Compared with nCT, nCRT significantly improved OS (HR = 0.80; 95% CI: 0.68–0.94), PFS (HR = 0.78; 95% CI: 0.66–0.93), pCR (OR = 13.00; 95% CI: 7.82–21.61) and R0 resection (OR = 1.84; 95% CI: 1.32–2.57), but was associated with higher postoperative mortality (OR = 2.31; 95% CI: 1.26–4.25) and grade 3 + AEs (OR = 2.21; 95% CI: 1.36–3.58). There was no significant difference in postoperative complications between nCRT and nCT (OR = 1.15; 95% CI: 0.82–1.61). Subgroup analysis showed significant survival benefit in squamous cell carcinoma (HR = 0.80; 95% CI: 0.68–0.98), but not in adenocarcinoma (HR = 0.80; 95% CI: 0.63–1.08). Conclusions: Our meta-analysis found superior efficacy associated with nCRT compared with nCT in both tumor regression and prolonged survival, but increased the risk of postoperative mortality and grade 3 + AEs. Esophageal squamous cell carcinoma was more likely to benefit from nCRT than esophageal adenocarcinoma in the term of OS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy in locally advanced esophageal cancer: An updated meta-analysis

Liang,

Chen,

et al. 2024

Medicine

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“…However, a meta-analysis of 17 randomised controlled trial (RCT)s, including more than 2800 patients, determined that neither neoadjuvant chemotherapy nor chemoradiotherapy were associated with increased risk of anastomotic leakage, a complication of particular concern among surgeons performing oesophageal resection surgery [32]. Other studies have drawn specific attention to increased incidence of pulmonary complications and vocal cord paralysis, although data from a second meta-analysis of 18 studies failed to demonstrate any statistically significant increase in risk for any of the included complications [33].…”

Section: Neoadjuvant Chemotherapy: Is There Significant Risk?mentioning

confidence: 99%

Patients Undergoing Systemic Anti-Cancer Therapy Who Require Surgical Intervention: What Surgeons Need to Know

Robinson

McNamara

Clouston

et al. 2023

Cancers

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As part of routine cancer care, patients may undergo elective surgery with the aim of long-term cure. Some of these patients will receive systemic anti-cancer therapy (SACT) in the neoadjuvant and adjuvant settings. The majority of patients, usually with locally advanced or metastatic disease, will receive SACT with palliative intent. These treatment options are expanding beyond traditional chemotherapy to include targeted therapies, immunotherapy, hormone therapy, radionuclide therapy and gene therapy. During treatment, some patients will require surgical intervention on an urgent or emergency basis. This narrative review examined the evidence base for SACT-associated surgical risk and the precautions that a surgical team should consider in patients undergoing SACT.

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Phase III randomized trial comparing neoadjuvant paclitaxel plus platinum with 5-fluorouracil plus platinum in esophageal or gastroesophageal junction squamous cell carcinoma

Noronha,

Patil,

Menon

et al. 2024

JNCI: Journal of the National Cancer Institute

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Background Standard neoadjuvant chemotherapy for locally advanced esophageal or gastroesophageal junction squamous cancer, 5-fluorouracil plus platinum, is toxic and logistically challenging; alternative regimens are needed. Methods This was a phase III randomized open-label noninferiority trial at Tata Memorial Center, India, in resectable locally advanced esophageal or gastroesophageal junction squamous cancer. Patients were randomly assigned 1:1 to 3 cycles of 3-weekly platinum (cisplatin 75 mg/m2 or carboplatin area under the curve 6) with paclitaxel 175 mg/m2 (day 1) or 5-fluorouracil 1000 mg/m2 continuous infusion (days 1-4), followed by surgery. Results Between August 2014 and June 2022, we enrolled 420 patients; 210 to each arm. Statistically significantly more patients on paclitaxel plus platinum (n =194, 92.3%) received all 3 chemotherapy cycles than on 5-fluorouracil with platinum (n = 170, 85.9%; P = .009). 5-fluorouracil plus platinum caused more grade 3 or higher toxicities (n = 124, 69.7%) than paclitaxel plus platinum (n = 97, 51.9%; P = .001). Surgery was performed in 131 (62.4%) patients on 5-fluorouracil plus platinum vs 139 (66.2%) on paclitaxel plus platinum (P = .415). Paclitaxel plus platinum resulted in higher pathologic primary tumor clearance (n = 33, 25.8%, vs n = 17, 15%; P = .04) and pathologic complete responses in 21.9% compared with 12.4% from 5-fluorouracil plus platinum (P = .053). Median overall survival was 27.5 months (95% confidence interval [CI] = 18.6 to 43.5 months) from paclitaxel plus platinum, which was noninferior to 27.1 months (95% CI = 18.8 to 40.7 months) from 5-fluorouracil plus platinum (hazard ratio [HR] = 0.89, 95% CI = 0.72 to 1.09; P = .346). Conclusion Neoadjuvant paclitaxel plus platinum chemotherapy is safer and results in similar R0 resections, higher pathologic tumor clearance and noninferior survival compared with 5-fluorouracil plus platinum. Paclitaxel plus platinum should replace 5-fluorouracil plus platinum as neoadjuvant chemotherapy for resectable locally advanced esophagealor gastroesophageal junction squamous cancer. Clinical Trials Registry India Number CTRI/2014/04/004516.

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Survival and complications after neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy for esophageal squamous cell cancer: A meta-analysis

Cited by 4 publications

References 41 publications

Efficacy and safety of neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy in locally advanced esophageal cancer: An updated meta-analysis

Efficacy and safety of neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy in locally advanced esophageal cancer: An updated meta-analysis

Patients Undergoing Systemic Anti-Cancer Therapy Who Require Surgical Intervention: What Surgeons Need to Know

Phase III randomized trial comparing neoadjuvant paclitaxel plus platinum with 5-fluorouracil plus platinum in esophageal or gastroesophageal junction squamous cell carcinoma

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