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Meta-Analysis
. 2022 Nov 2;6(6):zrac125.
doi: 10.1093/bjsopen/zrac125.

Definitive chemoradiotherapy versus neoadjuvant chemoradiotherapy followed by radical surgery for locally advanced oesophageal squamous cell carcinoma: meta-analysis

Sivesh K Kamarajah  1   2 , Richard P T Evans  1   2 , Ewen A Griffiths  1   2 , James A Gossage  3 , Philip H Pucher  4   5
Affiliations
Meta-Analysis

Definitive chemoradiotherapy versus neoadjuvant chemoradiotherapy followed by radical surgery for locally advanced oesophageal squamous cell carcinoma: meta-analysis

Sivesh K Kamarajah et al. BJS Open. .

Abstract

Background: The literature lacks robust evidence comparing definitive chemoradiotherapy (dCRT) with neoadjuvant chemoradiotherapy and surgery (nCRS) for oesophageal squamous cell carcinoma (ESCC). This study aimed to compare long-term survival of these approaches in patients with ESCC.

Methods: A systematic review performed according to PRISMA guidelines included studies identified from PubMed, Scopus, and Cochrane CENTRAL databases up to July 2021 comparing outcomes between dCRT and nCRS for ESCC. The main outcome measure was overall survival (OS), secondary outcome was disease-free survival (DFS). A meta-analysis was conducted using random-effects modelling to determine pooled adjusted multivariable hazard ratios (HRs).

Results: Ten studies including 14 092 patients were included, of which 30 per cent received nCRS. Three studies were randomized clinical trials (RCTs) and the remainder were retrospective cohort studies. dCRT and nCRS regimens were reported in six studies and surgical quality control was reported in two studies. Outcomes for OS and DFS were reported in eight and three studies respectively. Following meta-analysis, nCRS demonstrated significantly longer OS (HR 0.68, 95 per cent c.i. 0.54 to 0.87, P < 0.001) and DFS (HR 0.50, 95 per cent c.i. 0.36 to 0.70, P < 0.001) compared with dCRT.

Conclusion: Neoadjuvant chemoradiotherapy followed by oesophagectomy correlated with improved survival compared with definitive chemoradiation in the treatment of ESCC; however, there is a lack of literature on RCTs.

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Figures

Fig. 1.
Fig. 1.
Quality assessment flow chart
Fig. 2.
Fig. 2.
dCRT, definitive chemoradiotherapy; nCRT, neoadjuvant chemoradiotherapy and surgery; SCC, squamous cell carcinoma
Fig. 3.
Fig. 3.
Forest plot for effect of nCRS vs dCRT on overall survival. dCRT, definitive chemoradiotherapy; nCRS, neoadjuvant chemoradiotherapy and surgery; seTE, standard error of treatment estimate; TE, treatment effect
Fig. 4.
Fig. 4.
Forest plot of effect of nCRS vs dCRT on disease-free survival. dCRT, definitive chemoradiotherapy; nCRS, neoadjuvant chemoradiotherapy and surgery; seTE, standard error of treatment estimate; TE, treatment effect
See this image and copyright information in PMC

References

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