Systematic review of the benefits and risks of neoadjuvant chemoradiation for oesophageal cancer
Open Access
- 19 July 2010
- journal article
- research article
- Published by Oxford University Press (OUP) in British Journal of Surgery
- Vol. 97 (10), 1482-1496
- https://doi.org/10.1002/bjs.7175
Abstract
Background: Surgery alone for locally advanced oesophageal cancer is associated with low cure rates. The benefits and risks of neoadjuvant chemoradiation for patients with oesophageal cancer were evaluated. Methods: A systematic review of publications between 2000 and 2008 on neoadjuvant chemoradiation for oesophageal cancer was undertaken. Results: Thirty-eight papers comprising 3640 patients met the inclusion criteria. Chemoradiation regimens varied widely with a predominance of 5-fluorouracil/cisplatin chemotherapy. Chemoradiation-related toxicity was reported in only ten studies and consisted mainly of neutropenia. The chemoradiation-related mortality rate was 2·3 per cent. The mean R0 resection rate and pathological complete response (pCR) rate were 88·4 and 25·8 per cent respectively. Postoperative morbidity was not uniformly reported. The in-hospital mortality rate after oesophagectomy following chemoradiation was 5·2 per cent. Five-year survival rates varied from 16 to 59 per cent in all patients and from 34 to 62 per cent in those with a pCR. Chemoradiation had a temporary negative effect on quality of life. Conclusion: Neoadjuvant chemoradiation regimens for oesophageal cancer vary widely. Besides traditional outcome variables (such as survival), other parameters should be analysed (for example toxicity) to assess whether the risks of chemoradiation are sufficiently compensated for by the benefits.Funding Information
- Stichting Cornelis Vrolijk Development Fund
This publication has 80 references indexed in Scilit:
- Global Cancer Statistics, 2002CA: A Cancer Journal for Clinicians, 2005
- Neoadjuvant or adjuvant therapy for resectable esophageal cancer: a systematic review and meta-analysisBMC Medicine, 2004
- Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysisGut, 2004
- Preoperative chemotherapy for resectable thoracic esophageal cancerPublished by Wiley ,2003
- Biological basis for chemo-radiotherapy interactionsEuropean Journal of Cancer, 2002
- Chemoradiotherapy Followed by Surgery Compared with Surgery Alone in Squamous-Cell Cancer of the EsophagusThe New England Journal of Medicine, 1997
- A Comparison of Multimodal Therapy and Surgery for Esophageal AdenocarcinomaThe New England Journal of Medicine, 1996
- A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagusCancer, 1994
- Pre‐operative radiotherapy prolongs survival in operable esophageal carcinoma: A randomized, multicenter study of pre‐operative radiotherapy and chemotherapy. The second scandinavian trial in esophageal cancerWorld Journal of Surgery, 1992
- Combined modality therapy for esophageal squamous cell carcinomaCancer, 1983