Review: neoadjuvant chemoradiotherapy and chemotherapy improve survival in operable esophageal cancer.

M e t h o d s Data sources: Reference lists of previous systematic reviews, MEDLINE, EMBASE/ Excerpta Medica, Cancerlit, and lists of conference abstracts (1980 to 2006). Study selection and assessment: English-language randomized controlled trials (RCTs) that compared neoadjuvant chemoradiotherapy or chemotherapy followed by surgery with surgery alone in the initial management of operable esophageal cancer and did intention-to-treat analysis. 10 RCTs (n = 1209, median age 62 y, range 28 to 83 y) of neoadjuvant chemoradiotherapy and 8 RCTs (n = 1724, median age 63 y, range 30 to 84 y) of neoadjuvant chemotherapy met the selection criteria. Outcomes: Overall survival. M a i n r e s u l t s Chemoradiotherapy improved overall survival, but the effect of chemotherapy was smaller and of borderline statistical significance (Table). Chemoradiotherapy was effective for patients with squamous cell carcinoma (SCC) (hazard ratio [HR] for death 0.84, 95% CI 0.71 to 0.99) and with adenocarcinoma (HR 0.75, CI 0.59 to 0.95). In patients with SCC, concurrent chemoradiotherapy improved survival (HR 0.76, CI 0.59 to 0.98) but sequential chemoradiotherapy did not (HR 0.90, CI 0.72 to 1.03). Neoadjuvant chemotherapy improved survival for adenocarcinoma (HR 0.78, CI 0.64 to 0.95) but not for SCC (HR 0.88, 0.75 to 1.03) or mixed tumors (HR 1.07, CI 0.87 to 1.32).