The benefit of neoadjuvant chemoradiotherapy in esophageal cancer remains unclear.
In this study, researchers from Italy and the United States assessed the effectiveness of chemoradiotherapy followed by surgery in patients with resectable esophageal cancer.
The team performed computerized bibliographic searches of MEDLINE and CANCERLIT (1970 to 2002). They also performed hand searches of reference lists.
They included randomized controlled trials comparing preoperative chemoradiotherapy plus surgery with surgery alone. They included studies in which patients had resectable histologically proven esophageal cancer without metastatic disease.
|The risk for postoperative mortality was higher in the preoperative chemoradiotherapy group.|
The researchers identified 6 eligible randomized controlled trials.
The team found that chemoradiotherapy plus surgery, compared with surgery alone, significantly reduced the 3 year mortality rate (odds ratio 0.53).
They also found that preoperative chemoradiotherapy downstaged the tumor.
However, the risk for postoperative mortality was higher in the chemoradiotherapy plus surgery group (odds ratio 2.10).
Dr Fiorica and colleagues concluded, “In patients with resectable esophageal cancer, chemoradiotherapy plus surgery significantly reduces 3 year mortality compared with surgery alone”.
“However, postoperative mortality was significantly increased by neoadjuvant chemoradiotherapy”.
“Further large scale multicenter randomized controlled trials may prove useful to substantiate the benefit on overall survival”.