Neoadjuvant chemoradiotherapy for esophageal carcinoma: a meta-analysis.

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Surgery. 2005 Feb;137(2):172-7.

Comment in:
Surgery. 2005 Feb;137(2):178-9.

Neoadjuvant chemoradiotherapy for esophageal carcinoma: a meta-analysis.
 
Greer SE, Goodney PP, Sutton JE, Birkmeyer JD.
Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.

BACKGROUND:
The effectiveness in improving survival of neoadjuvant
chemoradiotherapy (NCRT) in patients undergoing surgery for esophageal
carcinoma remains unclear.
METHODS: MEDLINE, the Cochrane Database of
Systematic Reviews, BIOSIS Previews, and other resources were searched
from January 1966 through January 2003. Randomized trials were selected
on the basis of study design (NCRT followed by surgery vs surgery
alone). Of 21 potential studies identified by abstract review, 6 (29%)
met the inclusion criteria.
RESULTS: Across 6 studies, a total of 374
patients underwent NCRT followed by surgery and 364 underwent surgery
alone. In 5 of the 6 studies in our meta-analysis, there was a small,
non-statistically significant trend toward improved survival with NCRT.
Only 1 study demonstrated a statistically significant benefit to NCRT.
In our summary measure for all 6 studies, we found a small,
non-statistically significant trend toward improved long-term survival
in the NCRT followed by surgery group (relative risk of death in the
NCRT group [RR], 0.86; 95% confidence interval [CI], 0.74 to 1.01; P =
.07).
CONCLUSIONS: NCRT followed by surgery is associated with a small,
non-statistically significant improvement in overall survival. Whether
this benefit is sufficient to warrant the considerable expense and
risks associated with NCRT should be the subject of future larger
randomized trials.