Annals of Surgical Oncology

, Volume 10, Issue 7, pp 754–761 | Cite as

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

  • Ioannis G. Kaklamanos
  • Gail R. Walker
  • Kristian Ferry
  • Dido Franceschi
  • Alan S. Livingstone
Original Articles


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 cancer Meta-analysis Chemotherapy Radiotherapy Neoadjuvant Survival 


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Copyright information

© The Society of Surgical Oncology, Inc. 2003

Authors and Affiliations

  • Ioannis G. Kaklamanos
    • 1
  • Gail R. Walker
    • 2
  • Kristian Ferry
    • 1
  • Dido Franceschi
    • 1
    • 3
  • Alan S. Livingstone
    • 1
  1. 1.Division of Surgical OncologySylvester Cancer Center, University of MiamiMiami
  2. 2.Division of BiostatisticsSylvester Cancer Center, University of MiamiMiami
  3. 3.University of Miami School of MedicineSylvester Comprehensive Cancer Center, Division of Surgical Oncology (310T)Miami

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