In a meta-analysis reported in the Journal of Clinical Oncology, Faron et al found that neoadjuvant chemotherapy and chemoradiotherapy were associated with better survival vs upfront surgery in patients with thoracic esophageal or gastroesophageal junction (GEJ) carcinoma.
Study Details
The study involved investigation of published or unpublished randomized controlled trials closed to accrual before the end of December 2015 that compared at least two of the following strategies: upfront surgery, chemotherapy followed by surgery, and chemoradiotherapy followed by surgery. The primary endpoint was overall survival.
Key Findings
Individual patient data were obtained for 26 of 35 randomized controlled trials (4,985 of 5,807 patients) corresponding to 12 comparisons of chemotherapy followed by surgery vs upfront surgery, 12 of chemoradiotherapy followed by surgery vs upfront surgery, and 4 of chemoradiotherapy followed by surgery vs chemotherapy followed by surgery. Chemotherapy followed by surgery (hazard ratio [HR] = 0.86, 95% CI = 0.75–0.99, P = .03) and chemoradiotherapy followed by surgery (HR = 0.77, 95% CI = 0.68–0.87, P < .001) were associated with significantly improved overall survival vs upfront surgery.
In an individual patient data network meta-analysis adjusted for age, sex, tumor location, and histology, the hazard ratio for overall survival for chemoradiotherapy followed by surgery vs chemotherapy followed by surgery was 0.90 (95% CI = 0.74–1.09, P = .27; consistency P = .26, heterogeneity P = .0038). For chemotherapy followed by surgery vs upfront surgery, a greater benefit in overall survival was observed for GEJ vs thoracic esophageal tumors (P = .036). A larger benefit was observed among women for chemoradiotherapy followed by surgery vs upfront surgery (P = .003) and for chemoradiotherapy followed by surgery vs chemotherapy followed by surgery (P = .012).
The investigators concluded: “Neoadjuvant chemotherapy and chemoradiotherapy were consistently better than upfront surgery alone across histology, but with some variation in the magnitude of treatment effect by sex for chemoradiotherapy followed by surgery and tumor location for chemotherapy followed by surgery. A strong overall survival difference between chemotherapy followed by surgery and chemoradiotherapy followed by surgery was not identified.”
Matthieu Faron, MD, of Gustave Roussy, Villejuif, France, is the corresponding author of the Journal of Clinical Oncology article.
Disclosure: The study was supported by the French government Programme Hospitalier de Recherche Clinique en Cancérologie. For full disclosures of the study authors, visit ascopubs.org.
