Annals of Surgical Oncology

, Volume 10, Issue 7, pp 754–761

Neoadjuvant Treatment for Resectable Cancer of the Esophagus and the Gastroesophageal Junction: A Meta-Analysis of Randomized Clinical Trials

Authors

  • Ioannis G. Kaklamanos
    • Division of Surgical OncologySylvester Cancer Center, University of Miami
  • Gail R. Walker
    • Division of BiostatisticsSylvester Cancer Center, University of Miami
  • Kristian Ferry
    • Division of Surgical OncologySylvester Cancer Center, University of Miami
    • Division of Surgical OncologySylvester Cancer Center, University of Miami
    • University of Miami School of MedicineSylvester Comprehensive Cancer Center, Division of Surgical Oncology (310T)
  • Alan S. Livingstone
    • Division of Surgical OncologySylvester Cancer Center, University of Miami
Original Articles

DOI: 10.1245/ASO.2003.03.078

Cite this article as:
Kaklamanos, I.G., Walker, G.R., Ferry, K. et al. Ann Surg Oncol (2003) 10: 754. doi:10.1245/ASO.2003.03.078

Abstract

Background: There is no general agreement on the effect of neoadjuvant treatment for esophageal cancer on patient survival.

Methods: A meta-analysis was performed to determine the effect of preoperative treatment on survival of patients with resectable esophageal cancer and the effect of preoperative treatment on patient mortality. A standard variance-based method was used to derive summary estimates of the absolute difference in both 2-year survival and treatment-related mortality.

Results: Eleven randomized trials involving 2311 patients were analyzed. Preoperative chemotherapy improved 2-year survival compared with surgery alone: the absolute difference was 4.4% (95% confidence interval [CI], .3%–8.5%). Marginal evidence of heterogeneity was eliminated by restricting attention to the four most recent studies, which increased the estimate to 6.3% (95% CI, 1.8%–10.7%). For combined chemoradiotherapy, the increase was 6.4% (nonsignificant; 95% CI, −1.2%–14.0%). Treatment-related mortality increased by 1.7% with neoadjuvant chemotherapy (95% CI, −.9%—4.3%) and by 3.4% with chemoradiotherapy (95% CI, −.1%–7.3%), compared with surgery alone.

Conclusions: There seems to be a modest survival advantage for patients who receive neoadjuvant chemotherapy followed by surgery, as compared with surgery alone. There is an apparent increase in treatment-related mortality, mainly for patients who receive neoadjuvant chemoradiotherapy.

Key Words:

Esophageal cancerMeta-analysisChemotherapyRadiotherapyNeoadjuvantSurvival
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Copyright information

© The Society of Surgical Oncology, Inc. 2003