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Cochrane Database of Systematic Reviews

Preoperative chemotherapy for resectable thoracic esophageal cancer

Overview of attention for article published in Cochrane database of systematic reviews, May 2015
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Preoperative chemotherapy for resectable thoracic esophageal cancer
Published in
Cochrane database of systematic reviews, May 2015
DOI 10.1002/14651858.cd001556.pub3
Pubmed ID

Biniam Kidane, Shaun Coughlin, Kelly Vogt, Richard Malthaner


Surgery has been the treatment of choice for patients with localized esophageal cancer. Several studies have investigated whether preoperative chemotherapy followed by surgery leads to improvement in cure rates, but individual reports have provided conflicting results. An explicit systematic update of the role of preoperative chemotherapy in the treatment of patients with resectable thoracic esophageal cancer is, therefore, warranted. The objective of this review is to determine the role of preoperative chemotherapy in the treatment of patients with resectable thoracic esophageal carcinoma. We identified trials by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to 2013), EMBASE (1988 to 2013), and CANCERLIT (1993 to 2013). We did not confine our search to English language publications. We updated searches in CENTRAL, MEDLINE, and EMBASE in October 2013. All trials of patients with potentially resectable carcinoma of the esophagus (of any histologic type) who were randomly assigned to chemotherapy or no chemotherapy before surgery. The primary outcome was survival, which was assessed with the use of hazard ratios. This is an amendment to the original review, which used risk ratios to assess survival at yearly intervals. Hazard ratios (HRs) have now been introduced to summarize the complete survival experience in a single analysis. Risk ratios (RRs) were used to compare rates of resection, tumor recurrences, and treatment morbidity and mortality. We identified a total of 13 randomized trials involving 2362 participants. Ten trials (2122 participants) reported sufficient detail on survival to be included in a meta-analysis for the primary outcome. Preoperative chemotherapy improves overall survival (HR 0.88, 95% confidence interval (CI) 0.80 to 0.96) and is associated with a significantly higher rate of complete (R0) resection (RR 1.11, 95% CI 1.03 to 1.19).No evidence suggests that the overall rate of resection (RR 0.96, 95% CI 0.92 to 1.01), tumor recurrence (RR 0.81, 95% CI 0.54 to 1.22) or nonfatal complications (RR 0.90; 95% CI 0.76 to 1.06) was different for preoperative chemotherapy compared with surgery alone. Trials reported risks of toxicity with chemotherapy that ranged from 11% to 90%. In summary, preoperative chemotherapy plus surgery offers a survival advantage compared with surgery alone for patients with resectable thoracic esophageal cancer, but the evidence is of moderate quality. Some evidence of toxicity and preoperative mortality have been associated with chemotherapy.

Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 160 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Japan 1 <1%
United Kingdom 1 <1%
United States 1 <1%
Unknown 157 98%

Demographic breakdown

Readers by professional status Count As %
Student > Master 29 18%
Other 18 11%
Student > Ph. D. Student 18 11%
Student > Bachelor 14 9%
Student > Postgraduate 12 8%
Other 28 18%
Unknown 41 26%
Readers by discipline Count As %
Medicine and Dentistry 85 53%
Nursing and Health Professions 14 9%
Biochemistry, Genetics and Molecular Biology 4 3%
Psychology 3 2%
Computer Science 2 1%
Other 9 6%
Unknown 43 27%