| Effect of neoadjuvant chemoradiotherapy on prognosis and surgery for esophageal carcinoma. | |
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MedLine Citation:
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PMID: 19842230 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIM: To investigate the role of neoadjuvant chemoradiotherapy in prognosis and surgery for esophageal carcinoma by a meta-analysis. METHODS: PubMed and manual searches were done to identify all published randomized controlled trials (RCTs) that compared neoadjuvant chemoradiotherapy plus surgery (CRTS) with surgery alone (S) for esophageal cancer. According to the test of heterogeneity, a fixed-effect model or a random effect model was used and the odds ratio (OR) was the principal measure of effects. RESULTS: Fourteen RCTs that included 1737 patients were selected with quality assessment ranging from A to C (Cochrane Reviewers' Handbook 4.2.2). OR (95% CI, P value), expressed as CRTS vs S (values > 1 favor CRTS arm), was 1.19 (0.94-1.48, P = 0.28) for 1-year survival, 1.33 (1.07-1.65, P = 0.69) for 2-year survival, 1.76 (1.42-2.19, P = 0.11) for 3-year survival, 1.41 (1.06-1.87, P = 0.11) for 4-year survival, 1.64 (1.28-2.12, P = 0.40) for 5-year survival, 0.82 (0.39-1.73, P < 0.0001) for rate of resection, 1.53 (1.33-2.84, P = 0.007) for rate of complete resection, 1.78 (1.14-2.78, P = 0.79) for operative mortality, 1.12 (0.89-2.48, P = 0.503) for all treatment mortality, 1.33 (0.94-1.88, P = 0.04) for the rate of adverse treatment, 1.38 (1.23-1.63, P = 0.0002) for local-regional cancer recurrence, 1.28 (0.85-1.58, P = 0.60) for distant cancer recurrence, and 1.27 (0.86-1.65, P = 0.19) for all cancer recurrence. A complete pathological response to chemoradiotherapy occurred in 10%-45.5% of patients. The 5-year survival benefit was most pronounced when chemotherapy and radiotherapy were given concurrently (OR: 1.45, 95% CI: 1.26-1.79, P = 0.015) instead of sequentially (OR: 0.85, 95% CI: 0.64-1.35, P = 0.26). CONCLUSION: Compared with surgery alone, neoadjuvant chemoradiotherapy can improve the long-term survival and reduce local-regional cancer recurrence. Concurrent administration of neoadjuvant chemoradiotherapy was superior to sequential chemoradiotherapy. |
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Authors:
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Jin Lv; Xiu-Feng Cao; Bin Zhu; Lv Ji; Lei Tao; Dong-Dong Wang |
Publication Detail:
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Type: Journal Article; Meta-Analysis; Review |
Journal Detail:
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Title: World journal of gastroenterology : WJG Volume: 15 ISSN: 1007-9327 ISO Abbreviation: World J. Gastroenterol. Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-10-20 Completed Date: 2010-01-07 Revised Date: 2010-09-27 |
Medline Journal Info:
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Nlm Unique ID: 100883448 Medline TA: World J Gastroenterol Country: China |
Other Details:
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Languages: eng Pagination: 4962-8 Citation Subset: IM |
Affiliation:
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Oncology Center, Department of Surgery, Affiliated Nanjing First Hospital of Nanjing Medical University, 68 Changle Road, Nanjing 210006, Jiangsu Province, China. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Carcinoma
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drug therapy,
mortality,
radiotherapy,
secondary,
surgery,
therapy* Chemotherapy, Adjuvant Esophageal Neoplasms / drug therapy, mortality, radiotherapy, secondary, surgery, therapy* Esophagectomy* / mortality Evidence-Based Medicine Humans Neoadjuvant Therapy Neoplasm Recurrence, Local Odds Ratio Radiotherapy, Adjuvant Randomized Controlled Trials as Topic Risk Assessment Survival Analysis Time Factors Treatment Outcome |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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