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Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: systematic review with meta-analysis combining individual patient and aggregate data.

Publication ,  Journal Article
Ronellenfitsch, U; Schwarzbach, M; Hofheinz, R; Kienle, P; Kieser, M; Slanger, TE; Burmeister, B; Kelsen, D; Niedzwiecki, D; Schuhmacher, C ...
Published in: Eur J Cancer
October 2013

BACKGROUND: The prognosis of patients with gastroesophageal adenocarcinoma is poor. There is conflicting evidence regarding effects of preoperative chemotherapy on survival and other outcomes. METHODS: We conducted a meta-analysis with aggregate and individual patient data (IPD) to assess the effect of preoperative chemotherapy for gastroesophageal adenocarcinoma on survival and other outcomes. Two independent reviewers identified eligible randomised controlled trials (RCTs) comparing chemotherapy+/-radiotherapy followed by surgery with surgery alone for gastroesophageal adenocarcinoma. IPD was solicited from all trials. Meta-analyses were performed using the two stage method. RESULTS: We identified 14 RCTs (2422 patients). For eight RCTs (1049 patients; 43.3%) we obtained IPD. Preoperative chemotherapy was associated with longer overall survival (hazard ratio [HR] 0.81; 95% confidence interval [CI] 0.73-0.89; p<0.0001). There were larger treatment effects in tumours of the gastroesophageal junction and for chemoradiotherapy compared to chemotherapy, but the tests for subgroup differences were not statistically significant. Preoperative chemotherapy was associated with longer disease-free survival, higher likelihood of R0 resection and more favourable post-treatment tumour stage, but not perioperative complications. CONCLUSION: Preoperative chemotherapy for locoregional gastroesophageal adenocarcinoma increases survival compared to surgery alone. It should be offered to all eligible patients. There appear to be larger survival advantages in tumours of the gastroesophageal junction and for chemoradiotherapy, but these findings require prospective confirmation.

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Published In

Eur J Cancer

DOI

EISSN

1879-0852

Publication Date

October 2013

Volume

49

Issue

15

Start / End Page

3149 / 3158

Location

England

Related Subject Headings

  • Stomach Neoplasms
  • Randomized Controlled Trials as Topic
  • Prognosis
  • Preoperative Care
  • Oncology & Carcinogenesis
  • Kaplan-Meier Estimate
  • Humans
  • Esophageal Neoplasms
  • Disease-Free Survival
  • Chemoradiotherapy
 

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Ronellenfitsch, U., Schwarzbach, M., Hofheinz, R., Kienle, P., Kieser, M., Slanger, T. E., … Jensen, K. (2013). Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: systematic review with meta-analysis combining individual patient and aggregate data. Eur J Cancer, 49(15), 3149–3158. https://doi.org/10.1016/j.ejca.2013.05.029
Ronellenfitsch, Ulrich, Matthias Schwarzbach, Ralf Hofheinz, Peter Kienle, Meinhard Kieser, Tracy E. Slanger, Bryan Burmeister, et al. “Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: systematic review with meta-analysis combining individual patient and aggregate data.Eur J Cancer 49, no. 15 (October 2013): 3149–58. https://doi.org/10.1016/j.ejca.2013.05.029.
Ronellenfitsch U, Schwarzbach M, Hofheinz R, Kienle P, Kieser M, Slanger TE, et al. Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: systematic review with meta-analysis combining individual patient and aggregate data. Eur J Cancer. 2013 Oct;49(15):3149–58.
Ronellenfitsch, Ulrich, et al. “Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: systematic review with meta-analysis combining individual patient and aggregate data.Eur J Cancer, vol. 49, no. 15, Oct. 2013, pp. 3149–58. Pubmed, doi:10.1016/j.ejca.2013.05.029.
Ronellenfitsch U, Schwarzbach M, Hofheinz R, Kienle P, Kieser M, Slanger TE, Burmeister B, Kelsen D, Niedzwiecki D, Schuhmacher C, Urba S, van de Velde C, Walsh TN, Ychou M, Jensen K. Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: systematic review with meta-analysis combining individual patient and aggregate data. Eur J Cancer. 2013 Oct;49(15):3149–3158.
Journal cover image

Published In

Eur J Cancer

DOI

EISSN

1879-0852

Publication Date

October 2013

Volume

49

Issue

15

Start / End Page

3149 / 3158

Location

England

Related Subject Headings

  • Stomach Neoplasms
  • Randomized Controlled Trials as Topic
  • Prognosis
  • Preoperative Care
  • Oncology & Carcinogenesis
  • Kaplan-Meier Estimate
  • Humans
  • Esophageal Neoplasms
  • Disease-Free Survival
  • Chemoradiotherapy