Radiotherapy & Oncology
Esophageal cancer is in the top 10 common cancers around the world. For an advanced stage of this cancer, at stages II-III, the standard treatment is to go through chemotherapy (to chemically destroy cancer cells’ ability to replicate) and radiotherapy (to break cancer DNA with high-energy light), before the esophagectomy to resect the tumor. This order allows minimal cancer seeding with surgical removal, as undetectable number of cancer cells may remain even when the visible mass is removed. There is a recent study that suggests chemoradiotherapy alone may yield the same rate of mortality as chemoradiotherapy and surgery combined. This paper seeks to compare definitive chemoradiotherapy vs. neoadjuvant chemoradiotherapy plus surgery of esophageal and gastroesophageal cancer through means of systematic review and meta-analysis. Relevant records from Medline, Embase, and Cochrane Central Register of Controlled Trials, as well as literature from American Society of Clinical Oncology and European Society of Medical Oncology were sought. The articles with randomized controlled trials or observational studies with survival and/or toxicity data were chosen. A total of 8 articles, with 16,647 patients, were included for analysis. Overall, the neoadjuvant chemoradiotherapy with esophagectomy showed higher rates of survival compared to those who received definitive chemoradiotherapy. Regarding side effects, the combination therapy with surgery resulted in higher rates of anastomotic leak, esophageal necrosis, recurrent nerve paralysis resulting in hoarse voice, and pulmonary complications. The definitive chemoradiotherapy saw more rates of anemia, leukopenia, and nausea/vomiting.
Esophageal cancer is a common type of malignancy with marked rate of mortality. Chemotherapy, radiotherapy, and surgical interventions all cause multiple side effects and significantly reduce the quality of life for patients. Therefore, it is important to determine the most effective dose and treatment course. This paper is the largest systematic review of esophageal cancer treatment to date. This process further solidifies the validity of combination therapy that includes chemoradiotherapy on top of surgery.
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