Systematic review and network meta-analysis: Neoadjuvant chemoradiotherapy for locoregional esophageal cancer
Journal
Japanese Journal of Clinical Oncology
Journal Volume
45
Journal Issue
11
Pages
1023-1028
Date Issued
2015
Author(s)
Abstract
Objective: Neoadjuvant chemoradiotherapy improves survival in patients with locoregional esophageal cancer. This study compares the efficacy of two common regimens, paclitaxel plus platinum and platinum plus 5-fluorouracil, based on overall survival. Methods: We performed a systematic review and network meta-analysis of randomized trials comparing paclitaxel plus platinum-neoadjuvant chemoradiotherapy or and platinum plus 5-fluorouracilneoadjuvant chemoradiotherapy with surgery alone. The outcomewas the hazard ratios for death in the entire population and the two major histologic subgroups, squamous cell carcinoma and adenocarcinoma. Results: Ten clinical trials were included. Compared with surgery alone, the hazard ratios [95% credible interval (CrI)] in the entire, squamous cell carcinoma, and adenocarcinoma population were 0.63 (0.50-0.80), 0.50 (0.36-0.71) and 0.74 (0.54-1.01) for paclitaxel plus platinum, and 0.79 (0.68-0.92), 0.82 (0.67-1.01) and 0.81 (0.63-1.05) for platinum plus 5-fluorouracil, respectively. When paclitaxel plus platinum was compared with platinum plus 5-fluorouracil, the hazard ratios (95% CrI) in the entire, squamous cell carcinoma, and adenocarcinoma population were 0.80 (0.60-1.06), 0.61 (0.41- 0.91) and 0.91 (0.61-1.36), respectively. The probability of paclitaxel plus platinum being ranked the optimal treatment for the entire, squamous cell carcinoma, and adenocarcinoma population was 94.2, 99.1 and 67.6%, respectively. Conclusions: Neoadjuvant chemoradiotherapy with paclitaxel plus platinum regimen seemed to be a better treatment than platinum plus 5-fluorouracil regimen for locoregional esophageal cancer, especially for squamous cell carcinoma. ? The Author 2015. Published by Oxford University Press. All rights reserved.
SDGs
Other Subjects
carboplatin; cisplatin; fluorouracil; paclitaxel; platinum; antineoplastic agent; fluorouracil; paclitaxel; platinum derivative; adjuvant chemoradiotherapy; cancer staging; clinical trial (topic); drug efficacy; esophageal adenocarcinoma; esophageal squamous cell carcinoma; esophagus cancer; esophagus surgery; human; meta analysis; multiple cycle treatment; outcome assessment; overall survival; radiation dose fractionation; randomized controlled trial (topic); Review; systematic review; adenocarcinoma; adjuvant chemoradiotherapy; Carcinoma, Squamous Cell; Esophageal Neoplasms; neoadjuvant therapy; pathology; procedures; treatment outcome; Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Squamous Cell; Chemoradiotherapy, Adjuvant; Esophageal Neoplasms; Fluorouracil; Humans; Neoadjuvant Therapy; Paclitaxel; Platinum Compounds; Randomized Controlled Trials as Topic; Treatment Outcome
Publisher
Oxford University Press
Type
review