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Evidence summaries

Chemoradiotherapy Followed by Surgery for Oesophageal Cancer

Neoadjuvant chemoradiotherapy followed by surgery might possibly increase survival compared with surgery alone, but there is insufficient evidence for conclusions. Level of evidence: "D"

A systematic review 1 including 6 studies with a total of 738 patients was abstracted in DARE. NCRT plus surgery was associated with a slight improvement in overall survival compared with surgery alone. However, this was not statistically significant (RR of death 0.86, 95% CI: 0.74, 1.01, P=0.07). There was no evidence of statistical heterogeneity between the studies (P=0.41). A subgroup analysis of the four studies that only included patients with squamous cell carcinoma found no statistically significantly difference in overall survival (RR of death 0.94, 95% CI: 0.77, 1.13, P=0.5).

Comment: The quality of evidence is downgraded by imprecise results (few patients) and severe limitations in review methodology.

    References

    • Greer SE, Goodney PP, Sutton JE, Birkmeyer JD. Neoadjuvant chemoradiotherapy for esophageal carcinoma: a meta-analysis. Surgery 2005;137:172-177. [DARE]

Primary/Secondary Keywords