Role of adjuvant chemoradiotherapy in treatment of resectable esophageal carcinoma: a meta-analysis

Background The effectiveness and influence of surgery followed by adjuvant chemoradiotherapy (CRT) on the survival of patients with resectable esophageal carcinoma are still under debate. The outcomes of clinical trials have not been consistent. This study aimed to perform a meta-analysis of eligible published clinical trials to compare CRT with surgery without adjuvant chemoradiotherapy (non-CRT) for resectable esophageal carcinoma. Methods Computerized bibliographic and manual searches were undertaken to identify all eligible literature between 1990 and 2012. PubMed, EMBASE, Chinese National Knowledge Infrastructure, and Wanfang databases were our primary sources for published clinical trials. The quality of the methodology and reliability of the data from all of the clinical trials were assessed. All data were extracted by three independent researchers. Results Seven studies that included a total of 523 patients were selected. It was found that CRT significantly improved survival. The odds ratio (OR) in comparing CRT and non-CRT groups was 1.75 (95% confidence intervals (Cl): 1.17-2.60, P=0.006) for 1-year survival, 2.07 (95% Cl: 1.45-2.96, P<0.0001) for 3-year survival, and 2.17 (95% Cl: 1.45-3.26, P=0.0002) for 5-year survival. There have been no CRT treatment-related deaths reported in the literature. The incidence of related complications was high in the cases with CRT. Patients treated with CRT had a lower incidence of local-regional cancer recurrence (OR: 0.49, 95% Cl: 0.31-0.76, P=0.002) and a similar incidence of distant cancer recurrence (OR: 0.90, 95% Cl: 0.60-1.34, P=0.60). Conclusions it was found that patients with resectable esophageal carcinoma could gain a survival benefit from CRT. However, CRT was associated with a high incidence of related complications.