WITHDRAWN: Chemotherapy for metastatic carcinoma of the esophagus and gastro-esophageal junction

Abstract

Background: More than 50% of patients with esophageal cancer have metastatic disease at presentation. The use of chemotherapy for this patient group is increasing with the intention of local and distant tumor control, improving quality of life and prolongation of survival.

Objectives: To assess the effectiveness of a) chemotherapy versus best supportive care or b) different chemotherapy regimes against each other, in metastatic esophageal carcinoma.

Search strategy: Trials were identified by searching MEDLINE 1950- November week 3 2008, Central (Cochrane Library 4th Quarter 2008), Embase 1980 - 2008 week 50. We did not confine our search to English language publications. Searches in all databases were updated in February 2005, February 2006 and December 2008.The Cochrane Highly Sensitive Search Strategy for identifying randomized trials in MEDLINE, Sensitivity maximising version; Ovid format was combined with the following search terms to identify RCTs in MEDLINE. The MEDLINE search strategy was adapted for use in the other databases searched. Members of the Cochrane UGPD Group, and experts in the field were contacted and asked to provide details of outstanding clinical trials and any relevant unpublished materials.

Selection criteria: Randomized controlled trials comparing chemotherapy versus best supportive care, or different chemotherapy regimes against each other in patients with metastatic carcinoma of the esophagus or gastro-esophageal junction.

Data collection and analysis: Two authors (MYVH/EJK) extracted data and assessed trial quality. Study authors were contacted to obtain subgroup results of patients with metastatic esophageal carcinoma.

Main results: Only two RCTs with a total of 42 participants compared chemotherapy with best supportive care for metastatic esophageal cancer. No survival benefit was shown for chemotherapy treatment in these RCTs. Five RCTs with a total of 1242 participants compared different chemotherapy regimes. Due to variation in patient population and chemotherapy regimes, it was not possible to perform a formal pooled analysis. There was no consistent benefit of any specific chemotherapy regimen.

Authors' conclusions: There is a need for well designed, adequately powered, phase III trials comparing chemotherapy versus best supportive care for patients with metastatic esophageal cancer. Chemotherapy agents with promising response rates and tolerable toxicity are cisplatin, 5-fluorouracil (5-FU), paclitaxel and antracyclins. Future trials comparing palliative treatment modalities should assess quality of life with validated quality of life measures.