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World Journal of Surgery
Published in: World Journal of Surgery 5/2019

01-05-2019 | Esophagus Resection | Scientific Review

Definitive Chemoradiotherapy Versus Trimodality Therapy for Resectable Oesophageal Carcinoma: Meta-analyses and Systematic Review of Literature

Authors: Daan M. Voeten, Chantal M. den Bakker, David J. Heineman, Johannes C. F. Ket, Freek Daams, Donald L. van der Peet

Published in: World Journal of Surgery | Issue 5/2019

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Abstract

Background

Standard therapy for loco-regionally advanced, resectable oesophageal carcinoma is trimodality therapy (TMT) consisting of neoadjuvant chemoradiotherapy and oesophagectomy. Evidence of survival advantage of TMT over organ-preserving definitive chemoradiotherapy (dCRT) is inconclusive. The aim of this study is to compare survival between TMT and dCRT.

Methods

A systematic review and meta-analyses were conducted. Randomised controlled trials and observational studies on resectable, curatively treated, oesophageal carcinoma patients above 18 years were included. Three online databases were searched for studies comparing TMT with dCRT. Primary outcomes were 1-, 2-, 3- and 5-year overall survival rates. Risk of bias was assessed using the Cochrane risk of bias tools for RCTs and cohort studies. Quality of evidence was evaluated according to Grading of Recommendation Assessment, Development and Evaluation.

Results

Thirty-two studies described in 35 articles were included in this systematic review, and 33 were included in the meta-analyses. Two-, three- and five-year overall survival was significantly lower in dCRT compared to TMT, with relative risks (RRs) of 0.69 (95% CI 0.57–0.83), 0.76 (95% CI 0.63–0.92) and 0.57 (95% CI 0.47–0.71), respectively. When only analysing studies with equal patient groups at baseline, no significant differences for 2-, 3- and 5-year overall survival were found with RRs of 0.83 (95% CI 0.62–1.10), 0.81 (95% CI 0.57–1.14) and 0.63 (95% CI 0.36–1.12).

Conclusion

These meta-analyses do not show clear survival advantage for TMT over dCRT. Only a non-significant trend towards better survival was seen, assuming comparable patient groups at baseline. Non-operative management of oesophageal carcinoma patients might be part of a personalised and tailored treatment approach in future. However, to date hard evidence proving its non-inferiority compared to operative management is lacking.
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Metadata
Title
Definitive Chemoradiotherapy Versus Trimodality Therapy for Resectable Oesophageal Carcinoma: Meta-analyses and Systematic Review of Literature
Authors
Daan M. Voeten
Chantal M. den Bakker
David J. Heineman
Johannes C. F. Ket
Freek Daams
Donald L. van der Peet
Publication date
01-05-2019
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 5/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-018-04901-z

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