Efficacy and safety of neoadjuvant concurrent chemoradiotherapy followed by surgery versus surgery alone in the treatment of resectable esophageal squamous cell carcinoma: a Meta-analysis

中华放射肿瘤学杂志 Pub Date : 2020-01-15 DOI:10.3760/CMA.J.ISSN.1004-4221.2020.01.005

Ruilin Xie, Na Li, Qing-Feng Qin, Shengzi Wang, Xue Zhao, Zhaohui S. Qin, Yuanhu Yao

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Abstract

Objective To systematically evaluate the efficacy and safety between neoadjuvant concurrent chemoradiotherapy followed by surgery and surgery alone in the treatment of resectable esophageal squamous cell carcinoma. Methods Literature review was performed from Embase, PubMed, Web of Science, Cochrane Library, CBM, Wanfang Data, CNKI and Chongqing VIP. The randomized controlled clinical trials of concurrent chemoradiotherapy followed by surgery versus surgery alone in the treatment of resectable esophageal squamous cell carcinoma were retrieved. The meta-analysis of survival data, R0 resection rate, incidences of postoperative complications and peritreatment mortality was conducted by using RevMan 5.3 software. Results A total of 1450 patients from 11 controlled clinical trials were included in this meta-analysis. The results of the meta-analysis showed that concurrent chemoradiotherapy followed by surgery group had significantly higher 2-and 5-year overall survival rate (RR=1.14, 95%CI: 1.05-1.23, P=0.00) and progression-free survival rate (RR=1.56, 95%CI: 1.05-2.32, P=0.03). R0 resection rate were also improved in concurrent chemoradiotherapy followed by surgery group (RR=1.10, 95%CI: 1.05-1.14, P=0.00). Compared with the surgery alone group, the incidence of arrhythmia in the concurrent chemoradiotherapy plus surgery group was significantly higher (RR=2.45, 95%CI: 1.37-4.38, P=0.00). However, there was no significant difference in the overall incidence of postoperative complications (RR=1.12, 95%CI: 0.79-1.59, P=0.51) and incidence of peritreatment mortality (RR=1.78, 95%CI: 0.90-3.52, P=0.10) between two groups. Conclusions Neoadjuvant concurrent chemoradiotherapy followed by surgery improves the survival and R0 resection rate over surgery alone among patients with resectable esophageal squamous cell carcinoma, whereas it does not increase the risk of postoperative complications. Consequently, neoadjuvant concurrent chemoradiotherapy followed by surgery is an optimal treatment for patients with resectable esophageal squamous cell carcinoma. Key words: Esophageal neoplasm/neoadjuvant chemoradiotherapy; Esophageal neoplasm/surgery; Prognosis; Meta-analysis

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新辅助放化疗联合手术与单纯手术治疗可切除食管鳞状细胞癌的疗效和安全性：Meta分析

目的系统评价新辅助放化疗联合手术治疗可切除食管鳞状细胞癌的疗效和安全性。方法查阅Embase、PubMed、Web of Science、Cochrane Library、CBM、万方数据、CNKI和重庆VIP的文献。检索了同时放化疗和手术治疗可切除食管鳞状细胞癌的随机对照临床试验。使用RevMan 5.3软件对生存数据、R0切除率、术后并发症发生率和治疗后死亡率进行荟萃分析。结果本荟萃分析共纳入了来自11项对照临床试验的1450名患者。荟萃分析结果显示，同时放化疗后手术组的2年和5年总生存率（RR=1.14，95%CI:1.05-1.23，P=0.00）和无进展生存率（RR=1.56，95%CI:1.05-2.32，P=0.03）显著较高。与单纯手术组相比，放化疗联合手术组心律失常的发生率显著高于单纯手术组（RR=2.45，95%CI:1.37-4.38，P=0.00），两组术后并发症的总发生率（RR=1.12，95%CI:0.79-1.59，P=0.51）和治疗后死亡率（RR=1.78，95%CI:0.90-3.52，P=0.10）无显著差异。结论在可切除的食管鳞状细胞癌患者中，新辅助放化疗联合手术比单独手术提高了生存率和R0切除率，但不会增加术后并发症的风险。因此，对于可切除的食管鳞状细胞癌患者，新辅助同期放化疗和手术是一种最佳的治疗方法。关键词：食管肿瘤/新辅助放化疗；食道肿瘤/外科手术；预后；Meta分析

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来源期刊

中华放射肿瘤学杂志

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期刊介绍： The Chinese Journal of Radiation Oncology is a national academic journal sponsored by the Chinese Medical Association. It was founded in 1992 and the title was written by Chen Minzhang, the former Minister of Health. Its predecessor was the Chinese Journal of Radiation Oncology, which was founded in 1987. The journal is an authoritative journal in the field of radiation oncology in my country. It focuses on clinical tumor radiotherapy, tumor radiation physics, tumor radiation biology, and thermal therapy. Its main readers are middle and senior clinical doctors and scientific researchers. It is now a monthly journal with a large 16-page format and 80 pages of text. For many years, it has adhered to the principle of combining theory with practice and combining improvement with popularization. It now has columns such as monographs, head and neck tumors (monographs), chest tumors (monographs), abdominal tumors (monographs), physics, technology, biology (monographs), reviews, and investigations and research.