Twenty-eight RCTs were included in the review; 20 RCTs were included in the meta-analysis (3,318 patients). Results of quality assessment were not provided in full but the authors concluded that, although most trials did not provide sufficient details of randomisation, allocation concealment was not compromised. Median follow-up, ranged from 10 months to 98 months (where reported).
Neoadjuvant chemoradiotherapy followed by surgery versus surgery alone (nine RCTs; 1,099 patients, range 56 to 282): The likelihood of complete oesophageal cancer resection (R0, no residual tumour) was significantly greater after neoadjuvant chemoradiotherapy (HR 1.15, 1.00 to 1.32) compared with surgery alone; a high level of heterogeneity was noted (Ι²=84%). Survival after neoadjuvant chemoradiotherapy was statistically significantly greater than after surgery alone (HR 0.81, 0.70 to 0.95); there was no evidence of heterogeneity (Ι²=13%). No statistically significant differences were found in postoperative morbidity and mortality between the treatment groups.
Neoadjuvant chemotherapy followed by surgery versus surgery alone (eight RCTs; 1,707 patients, range 39 to 802): The likelihood of complete R0 cancer resection was significantly greater after neoadjuvant chemotherapy (HR 1.16, 1.05 to 1.30) compared with surgery alone; some heterogeneity was noted (Ι²=48%). No statistically significant differences were found in overall survival, postoperative morbidity and mortality between the treatment groups.
Definitive chemoradiotherapy versus neoadjuvant treatment followed by surgery or surgery alone (three RCTs; 512 patients, range 81 to 259): Mortality risk was lower in the definitive chemoradiotherapy group (HR 7.60, 1.76 to 32.88, p = 0.007); there was no statistically significant heterogeneity (Ι²=0%). There were no statistically significant differences in overall survival or morbidity between treatment groups.