RESUMEN
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether trimodal therapy [neoadjuvant chemoradiotherapy (nCRT) in addition to surgery] improves survival in patients with resectable oesophageal cancer. Altogether 565 studies were identified using the below-mentioned search. Eleven represented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group, relevant outcomes and weaknesses are tabulated. All 11 studies were randomized controlled trials comparing surgery with trimodal therapy, 5 of which showed a survival advantage with combined treatment. The remaining six randomized controlled trials showed no difference between trimodal therapy and surgery alone. The 3-year survival for trimodal treatment varied between 19.3 and 58% compared with that for surgery alone which varied between 7 and 53%. Five of these studies compared trimodal therapy with surgery in terms of resection margins, three of which showed that trimodal therapy led to increased R0 resection rate. One study focused on the differences between adenocarcinoma and squamous cell tumours, and described equivalent effects of trimodal therapy in terms of survival. One randomized controlled trial showed improved survival in patients with complete regression of their tumour following induction treatment. Two studies suggested that induction treatment may lead to a higher operative mortality; however, an increase in disease-free survival was noted in one of the two studies. We conclude that trimodal therapy for resectable oesophageal cancer offers similar or even improved results compared with surgery alone in terms of survival. Furthermore, it is likely that there is an advantage for those patients who have a complete pathological response following induction treatment.
Asunto(s)
Carcinoma/mortalidad , Carcinoma/terapia , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/terapia , Quimioradioterapia , Supervivencia sin Enfermedad , Esofagectomía , Humanos , Terapia Neoadyuvante , Ensayos Clínicos Controlados Aleatorios como Asunto , Tasa de SupervivenciaRESUMEN
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether induction (neoadjuvant) chemoradiotherapy (iCRT) compared with other therapeutic strategies improves survival in patients with Pancoast tumours. Altogether 248 papers were identified using the below-mentioned search. Ten of them represented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group, relevant outcomes and weaknesses were tabulated. Four studies were retrospective comparative studies of induction chemoradiotherapy and surgery (trimodal therapy) versus other therapeutic strategies. Two studies were retrospective and four were prospective investigating trimodal therapy. These papers comprised a total of 550 patients. The overall survival was better with trimodal therapy compared with RT (radiotherapy) followed by surgery group in all three comparative studies. The 2-year survival varied in the trimodal therapy group from 70 to 93%, in comparison to RT group where variation was from 22 to 49%. Five-year survival for trimodal therapy varied between 36.4 and 84% in the results of two comparative studies, compared with 11 and 49% for RT and surgery, respectively. One paper looked at survival in patients who underwent surgery alone [30% at 2-year and 20% at 4-year overall survival (OS)]. The 5-year OS in the retrospective group varied between 38 and 59%. Similar results were reported for the prospective group with 5-year OS between 44 and 56%. Despite a large variation in pCR (complete pathological response) (15-93%) and R0 (77-100%) reported, both represented a positive prognostic factor for survival. Three papers looked at the impact of staging following induction chemoradiotherapy. The majority of patients had T3 disease. An advantage in survival was seen in patients with early disease compared with advanced stage. No randomized controlled trials were identified. All the 10 articles suggested there was a benefit in trimodal therapy with improvement in overall survival. We conclude that combining induction chemoradiotherapy with surgery for Pancoast tumour may offer a survival benefit compared with radiotherapy with surgery or surgery alone.