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From the Division of Surgical Oncology (IGK, KF, DF, ASL) and the Division of Biostatistics (GRW), Sylvester Cancer Center, University of Miami, Miami, Florida.
Correspondence: Address correspondence and reprint requests to: Dido Franceschi, MD, University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, Division of Surgical Oncology (310T), 1475 NW 12th Avenue, Room 3550, Miami, FL 33136; Fax: 305-243-4907; E-mail: dfrances{at}med.miami.edu
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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