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 Livingstone

Research output: Contribution to journalArticle

229 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)754-761
Number of pages8
JournalAnnals of Surgical Oncology
Volume10
Issue number7
DOIs
StatePublished - Dec 1 2003

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Esophagogastric Junction
Neoadjuvant Therapy
Esophageal Neoplasms
Meta-Analysis
Randomized Controlled Trials
Confidence Intervals
Chemoradiotherapy
Survival
Mortality
Drug Therapy
Therapeutics

Keywords

  • Chemotherapy
  • Esophageal cancer
  • Meta-analysis
  • Neoadjuvant
  • Radiotherapy
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Neoadjuvant treatment for resectable cancer of the esophagus and the gastroesophageal junction : A meta-analysis of randomized clinical trials. / Kaklamanos, Ioannis G.; Walker, Gail R.; Ferry, Kristian; Franceschi, Dido; Livingstone, Alan.

In: Annals of Surgical Oncology, Vol. 10, No. 7, 01.12.2003, p. 754-761.

Research output: Contribution to journalArticle

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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.",
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AU - Franceschi, Dido

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N2 - 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.

AB - 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.

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