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INTERDISCIPLINARY REPORTING OF OUTCOMES: A META-ANALYSIS OF DEFINITIVE CHEMORADIATION VS. SURGERY FOR ESOPHAGEAL CANCER
Andrea Wirsching*1, Sheraz R. Markar2, Mustapha El Lakis3, Donald Low1
1General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA; 2Department of Surgery and Cancer, Imperial College London, London, United Kingdom; 3Endocrine Oncology Branch, National Cancer Institute, Center for Cancer Research, Bethesda, MD
Background: Definitive chemoradiotherapy has been suggested as an alternative to surgery for the treatment of esophageal cancer. A decrease in mortality and morbidity with similar long-term survival has been proposed in favor of definitive chemoradiotherapy. With this meta-analysis we aimed to summarize current evidence comparing short-term outcomes and long-term outcomes associated with surgery and definitive chemoradiotherapy.
Methods: Embase, Medline, Web of Science and Cochrane library databases were searched for randomized controlled trials (RCT) or cohort studies comparing definitive chemoradiotherapy with surgery for esophageal cancer. Studies published after 2000 and including more than 10 patients per study arm were included.
Results: Fourteen studies were identified, which met all inclusion criteria. There were 2 RCT and 12 cohort studies. 30-day mortality and 90-day mortality were reported in 7 and 5 studies for the surgery group and in 5 and 3 studies for the dCRT group. Median 30-day mortality was 0% associated with dCRT and 5% (range 0-8%) associated with surgery (p=0.035). Overall morbidity was reported in 4 and 9 studies for the dCRT and surgery groups, respectively. Adverse events were systematically graded in 9 and 1 study for the dCRT and surgery groups, respectively. There was no difference in one- and two-year overall survival, disease-free survival and overall recurrence. Surgery was associated with a reduction in locoregional recurrence compared to definitive chemoradiotherapy (p=0.027).
Conclusion: Comparison of short-term outcomes after definitive chemoradiotherapy vs. surgery remains poor, since mortality and morbidity are reported heterogeneously and inconsistently. There is a need for a common language in order to compare different treatment modalities for esophageal cancer treatment. Long-term outcomes were reported more consistently and did not show superiority of one treatment modality.
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