The role of definitive chemoradiotherapy versus surgery as initial treatments for potentially resectable esophageal carcinoma

Abstract

Background: We performed a meta-analysis to compare the efficacy of definitive chemoradiotherapy (dCRT) and esophagectomy as initial treatments for potentially resectable esophageal cancer. Methods: To assess both strategies, the combined odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Thirteen studies (N=2071; dCRT=869 and surgery=1202) were included. In all, 90.39% of the patients were diagnosed with esophageal squamous cell carcinoma (ESCC). Results: The 2-year (OR=1.199, 95% CI 0.922-1.560; P=0.177) and 5-year overall survival (OS) rates (OR=0.947, 95% CI 0.628-1.429; P=0.796) were not significantly different. No significant differences were identified in the 2-year OS among patients with stage I disease (OR=1.397, 95% CI 0.740-2.638; P=0.303) or stage II-III (OR=0.418, 95% CI 0.022-7.833; P=0.560). Patients with lymph node metastases tended to have a better 5-year OS when treated with dCRT than with surgery (OR=0.226, 95% CI 0.044-1.169; P=0.076); however, the difference between the two methods was not significant. Western patients who received dCRT had poorer prognoses than patients who underwent surgery (OR=1.522, 95% CI 1.035-2.238; P=0.033). dCRT and surgery led to similar 5-year progression-free survival rates (OR=1.06, 95% CI 0.79-1.42; P=0.70). Conclusions: dCRT and surgery are equally effective as initial treatments for potentially resectable esophageal cancer. These results apply primarily to Asian populations as they have an increased incidence of ESCC.