Systematic review of the benefits and risks of neoadjuvant chemoradiation for oesophageal cancer

Staal, Ewout F. W. Courrech; Aleman, Berthe M.P.; Boot, H.; Velthuysen, Marie‐Louise F. van; Tinteren, Harm van; Sandick, J. W. van

doi:10.1002/bjs.7175

Cited by 123 publications

(61 citation statements)

References 85 publications

(461 reference statements)

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“…; P \ 0.001) [2]. A systematic review of the benefits and risks of neoadjuvant chemoradiotherapy for esophageal cancer showed a mean R0 resection rate of 88.4 % and a pathological complete response of 25.8 %, respectively [41].…”

Section: Kpi No 2: Oncologic Radicalitymentioning

confidence: 99%

Quality Management and Key Performance Indicators in Oncologic Esophageal Surgery

Gockel¹,

Ahlbrand

Arras

et al. 2015

Dig Dis Sci

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Ranking systems and comparisons of quality and performance indicators will be of increasing relevance for complex "high-risk" procedures such as esophageal cancer surgery. The identification of evidence-based standards relevant for key performance indicators in esophageal surgery is essential for establishing monitoring systems and furthermore a requirement to enhance treatment quality. In the course of this review, we analyze the key performance indicators case volume, radicality of resection, and postoperative morbidity and mortality, leading to continuous quality improvement. Ranking systems established on this basis will gain increased relevance in highly complex procedures within the national and international comparison and furthermore improve the treatment of patients with esophageal carcinoma.

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Section: Kpi No 2: Oncologic Radicalitymentioning

confidence: 99%

Quality Management and Key Performance Indicators in Oncologic Esophageal Surgery

Gockel¹,

Ahlbrand

Arras

et al. 2015

Dig Dis Sci

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“…There is evidence that neoadjuvant chemoradiotherapy increases the rate of complete resection [5], particularly for patients with locally advanced disease. Many randomized controlled trials (RCTs) have generated promising results with respect to 5-year survival rates.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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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

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“…In theory, this rationale is sound. In practice, however, great variability in neoadjuvant regimens exists between centers,(5) and, when studied in randomized controlled trials, comparisons between multimodal therapy and surgery alone yield conflicting results. (6–11) Lack of consistent neoadjuvant regimens is compounded by the limitations of clinical staging,(12–17) and differences in approach to esophagectomy, extent of lymphadenectomy and perioperative outcomes between centers.…”

Section: Introductionmentioning

confidence: 99%

A propensity-matched analysis comparing survival after primary minimally invasive esophagectomy followed by adjuvant therapy to neoadjuvant therapy for esophagogastric adenocarcinoma

Zahoor

Luketich

Levy

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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Objectives Prognosis for locally advanced esophagogastric adenocarcinoma (EAC) is poor with surgery alone and adjuvant therapy after open esophagectomy is frequently not tolerated. After minimally invasive esophagectomy (MIE), however, earlier return to normal function may render patients better able to receive adjuvant therapy. This study examined whether primary MIE followed by adjuvant chemotherapy impacted survival compared to propensity-matched patients treated with neoadjuvant therapy. Methods Patients with stage II or higher EAC treated with MIE (n=375) were identified. Using 30 pretreatment covariates, propensity for assignment to either neoadjuvant followed by MIE (n=183; 54%) or MIE as primary therapy (n=156; 46%) was calculated, generating 97 closely-matched pairs. Hazard ratios were adjusted for age, sex, BMI, smoking, comorbidity and final pathologic stage. Results In propensity-matched pairs, adjusted hazard ratio for death did not differ significantly for primary MIE compared to neoadjuvant (HR 0.83; 95% CI 0.60–1.16). Recurrence patterns were similar between groups and 65% of patients with IIb or greater pathologic stage received adjuvant therapy. Clinical staging was inaccurate in 37/105 (35%) patients who underwent primary MIE (n=18 upstaged and n=19 downstaged). Conclusions Primary MIE followed by adjuvant chemotherapy guided by pathologic findings did not negatively impact survival and allowed for accurate staging of the patient compared to clinical staging. Our data suggest that primary MIE in patients with resectable EAC may be a reasonable approach, improving stage-based prognostication and potentially minimizing overtreatment in patients with early-stage disease through accurate stage assignments. A randomized controlled trial testing this hypothesis is needed.

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Systematic review of the benefits and risks of neoadjuvant chemoradiation for oesophageal cancer

Abstract: Neoadjuvant chemoradiation regimens for oesophageal cancer vary widely. Besides traditional outcome variables (such as survival), other parameters should be analysed (for example toxicity) to assess whether the risks of chemoradiation are sufficiently compensated for by the benefits.

Cited by 123 publications

References 85 publications

Quality Management and Key Performance Indicators in Oncologic Esophageal Surgery

Quality Management and Key Performance Indicators in Oncologic Esophageal Surgery

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

A propensity-matched analysis comparing survival after primary minimally invasive esophagectomy followed by adjuvant therapy to neoadjuvant therapy for esophagogastric adenocarcinoma

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