Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: Systematic review with meta-analysis combining individual patient and aggregate data

Ronellenfitsch, Ulrich, Schwarzbach, Matthias, Hofheinz, Ralf, Kienle, Peter, Kieser, Meinhard, Slanger, Tracy E., Burmeister, Bryan, Kelsen, David, Niedzwiecki, Donna, Schuhmacher, Christoph, Urba, Susan, van de Velde, Cornelis, Walsh, Thomas N., Ychou, Marc and Jensen, Katrin (2013) Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: Systematic review with meta-analysis combining individual patient and aggregate data. European Journal of Cancer, 49 15: 3149-3158. doi:10.1016/j.ejca.2013.05.029


Author Ronellenfitsch, Ulrich
Schwarzbach, Matthias
Hofheinz, Ralf
Kienle, Peter
Kieser, Meinhard
Slanger, Tracy E.
Burmeister, Bryan
Kelsen, David
Niedzwiecki, Donna
Schuhmacher, Christoph
Urba, Susan
van de Velde, Cornelis
Walsh, Thomas N.
Ychou, Marc
Jensen, Katrin
Title Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: Systematic review with meta-analysis combining individual patient and aggregate data
Journal name European Journal of Cancer   Check publisher's open access policy
ISSN 0959-8049
1879-0852
Publication date 2013-10
Year available 2013
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1016/j.ejca.2013.05.029
Open Access Status
Volume 49
Issue 15
Start page 3149
End page 3158
Total pages 10
Place of publication Kidlington, Oxford, United Kingdom
Publisher Pergamon
Collection year 2014
Language eng
Formatted abstract
Background
The prognosis of patients with gastroesophageal adenocarcinoma is poor. There is conflicting evidence regarding effects of preoperative chemotherapy on survival and other outcomes.

Methods
We conducted a meta-analysis with aggregate and individual patient data (IPD) to assess the effect of preoperative chemotherapy for gastroesophageal adenocarcinoma on survival and other outcomes. Two independent reviewers identified eligible randomised controlled trials (RCTs) comparing chemotherapy+/–radiotherapy followed by surgery with surgery alone for gastroesophageal adenocarcinoma. IPD was solicited from all trials. Meta-analyses were performed using the two stage method.

Results
We identified 14 RCTs (2422 patients). For eight RCTs (1049 patients; 43.3%) we obtained IPD. Preoperative chemotherapy was associated with longer overall survival (hazard ratio [HR] 0.81; 95% confidence interval [CI] 0.73–0.89; p < 0.0001). There were larger treatment effects in tumours of the gastroesophageal junction and for chemoradiotherapy compared to chemotherapy, but the tests for subgroup differences were not statistically significant. Preoperative chemotherapy was associated with longer disease-free survival, higher likelihood of R0 resection and more favourable post-treatment tumour stage, but not perioperative complications.

Conclusion
Preoperative chemotherapy for locoregional gastroesophageal adenocarcinoma increases survival compared to surgery alone. It should be offered to all eligible patients. There appear to be larger survival advantages in tumours of the gastroesophageal junction and for chemoradiotherapy, but these findings require prospective confirmation. 
Keyword Gastroesophageal adenocarcinoma
Oesophageal cancer
Stomach cancer
Preoperative chemotherapy
Preoperative chemoradiotherapy
Systematic review
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2014 Collection
School of Medicine Publications
 
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