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The role of definitive chemoradiotherapy versus surgery as initial treatments for potentially resectable esophageal carcinoma.

ABSTRACT: BACKGROUND:We performed a meta-analysis to compare the efficacy of definitive chemoradiotherapy (dCRT) and esophagectomy as initial treatments for potentially resectable esophageal cancer. METHODS:To assess both strategies, the combined odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Thirteen studies (N?=?2071; dCRT?=?869 and surgery?=?1202) were included. In all, 90.39% of the patients were diagnosed with esophageal squamous cell carcinoma (ESCC). RESULTS:The 2-year (OR?=?1.199, 95% CI 0.922-1.560; P?=?0.177) and 5-year overall survival (OS) rates (OR?=?0.947, 95% CI 0.628-1.429; P?=?0.796) were not significantly different. No significant differences were identified in the 2-year OS among patients with stage I disease (OR?=?1.397, 95% CI 0.740-2.638; P?=?0.303) or stage II-III (OR?=?0.418, 95% CI 0.022-7.833; P?=?0.560). Patients with lymph node metastases tended to have a better 5-year OS when treated with dCRT than with surgery (OR?=?0.226, 95% CI 0.044-1.169; P?=?0.076); however, the difference between the two methods was not significant. Western patients who received dCRT had poorer prognoses than patients who underwent surgery (OR?=?1.522, 95% CI 1.035-2.238; P?=?0.033). dCRT and surgery led to similar 5-year progression-free survival rates (OR?=?1.06, 95% CI 0.79-1.42; P?=?0.70). CONCLUSIONS:dCRT and surgery are equally effective as initial treatments for potentially resectable esophageal cancer. These results apply primarily to Asian populations as they have an increased incidence of ESCC.

SUBMITTER: Ma MW

PROVIDER: S-EPMC6097217 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Project description:This study compares neoadjuvant chemoradiotherapy (nCRT) with perioperative chemotherapy (pCT) for patients with resectable esophageal or gastroesophageal junction (GEJ) adenocarcinoma in terms of toxicity, postoperative complications, pathologic response, and survival.This study retrospectively analyzed and compared 313 patients with resectable esophageal or GEJ adenocarcinoma treated with either nCRT (carboplatin/paclitaxel 41.4 Gy, n = 176) or pCT (epirubicin, cisplatin and capecitabine, n = 137).The baseline and tumor characteristics were similar in both groups. The ability to deliver all planned preoperative cycles was greater in the nCRT group (92.0 vs. 76.6%). Whereas nCRT was associated with a higher rate of grades 3 and 4 esophagitis, pCT was associated with a higher rate of grades 3 and 4 thromboembolic events, febrile neutropenia, nausea, vomiting, diarrhea, hand-foot syndrome, mucositis, cardiac complications, and electrolyte imbalances. Two patients in the pCT group died during neoadjuvant treatment due to febrile neutropenia. More postoperative cardiac complications occurred in the nCRT group. All other postoperative complications and the in-hospital mortality rate (nCRT, 4.7%; pCT, 2.3%) were comparable. The pathologic complete response (pCR) rate was 15.1% after nCRT and 6.9% after pCT. Radicality of surgery was comparable (R0: 93.0 vs. 91.6%). The median overall survival was 35 months after nCRT versus 36 months after pCT.For patients with esophageal or GEJ adenocarcinoma, chemoradiotherapy with paclitaxel, carboplatin and concurrent radiotherapy, and perioperative chemotherapy with epirubicin, cisplatin, and capecitabin lead to equal oncologic outcomes in terms of radical resection rates, lymphadenectomy, patterns of recurrent disease, and (disease-free) survival. However, neoadjuvant chemoradiotherapy is associated with a considerably lower level of severe adverse events and should therefore be the preferred protocol until a well-powered randomized controlled trial provides different insights.

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The role of definitive chemoradiotherapy versus surgery as initial treatments for potentially resectable esophageal carcinoma.

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