KEY TAKEAWAYS
- The study aimed to investigate the comparative efficacy and safety of nCT versus nCRT in reducing the clinical stage of patients with EC.
- Researchers observed higher pCR rates with nCRT, but it doesn’t correlate with long-term survival. However, nCRT entails higher 30-day mortality.
Neoadjuvant therapy is essential in the management of esophageal cancer (EC), facilitating downstaging and enhancing the potential for curative treatment. Nevertheless, the comparative efficacy between neoadjuvant chemotherapy (nCT) and neoadjuvant chemoradiotherapy (nCRT) remains ambiguous, prompting a comprehensive examination of these modalities.
Armand Csontos and the team aimed to assess the therapeutic outcomes and safety profiles associated with nCT and nCRT in patients with EC.
They performed an inclusive analysis to address this concern, establishing predefined criteria using the PICO protocol. Two independent authors conducted comprehensive searches employing predetermined keywords. Statistical analyses were then undertaken to identify significant differences between groups. Funnel plots were utilized to visualize potential publication bias. Data quality was evaluated using the Risk of Bias Tool 2 (RoB2) and the GRADE approach.
The analysis utilized 10 articles involving 1928 patients. A significant difference was detected in pathological complete response (pCR) (P < 0.001; odds ratio (OR): 0.27; 95%CI: 0.16-0.46), 30-day mortality (P = 0.015; OR: 0.4; 95%CI: 0.22-0.71) favoring the nCRT, and renal failure (P = 0.039; OR: 1.04; 95%CI: 0.66-1.64) favoring nCT.
No significant differences were observed regarding survival, local or distal recurrence, or other clinical or surgical complications. RoB2’s result was moderate, and the GRADE approach was low or very low in almost all cases.
The study concluded that although nCRT may exhibit a higher pCR rate, this does not translate into superior long-term survival. Furthermore, nCRT is linked to elevated 30-day mortality without a clear identification of specific causes for postoperative complications. nCT is suspected of inducing toxic side effects, potentially compromising the quality of life. Given the quality of available studies, further randomized trials are necessary.
No funding-related information was available.
Source: https://pubmed.ncbi.nlm.nih.gov/38617451/
Csontos A, Fazekas A, Szakó L, et al. (2024). “Effects of neoadjuvant chemotherapy vs chemoradiotherapy in the treatment of esophageal adenocarcinoma: A systematic review and meta-analysis.” World J Gastroenterol. 2024 Mar 21;30(11):1621-1635. doi: 10.3748/wjg.v30.i11.1621. PMID: 38617451; PMCID: PMC11008422.
