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Neoadjuvant Therapy for Resectable Oesophageal Carcinoma: A Systematic Review of Randomized Controlled Trials

Author: XuXiaoHua
Tutor: LiKe
School: Shantou University
Course: Epidemiology and Biostatistics,
Keywords: Esophageal cancer Neoadjuvant chemotherapy (put ) Surgery Randomized controlled trials System Evaluation Meta- analysis Evidence-Based Medicine
CLC: R735.1
Type: Master's thesis
Year: 2011
Downloads: 41
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Purpose: The use of a systematic evaluation of clear surgical resection of esophageal cancer underwent preoperative auxiliary (put) chemotherapy, a comprehensive exposition of the efficacy of adjuvant therapy in the preoperative today explore preoperative auxiliary (put) chemotherapy good chemotherapy Learn more about esophageal cancer efficacy of new chemotherapy drugs. Methods: a systematic review of the randomized controlled trials. Follow the collection policy of the Cochrane the esophageal collaboration group retrieval databases: CCTR (Cochrane Controlled Trials Register) 20l0.issue.4; PubMed (1980-2010.12); Ovid Evidence-Based Medicine database (1991-2010); CBM-disc (China Biological Medicine Database 1978 2010.12); [Academic Journal (VIP ,1989-2010 .12); Chinese Academic Journal (CNKI ,1979-2010 .12) and Wanfang Data Resource System (1983-2010.12); summary of the meeting of the American Society of Clinical Oncology ; the Chinese esophageal disease clinical research database; Tracking retrieve the relevant overview, the paper references. We included the preoperative the auxiliary (put) chemotherapy, confounders real randomized controlled trials (RCTs), two reviewers according to each of the included studies used random allocation concealment situation, whether blinded, whether the intention-to-treat analysis and the number of patients lost to quality assessment and data collection of literature. Statistical software with Cochrane Collaboration RevMan5.0.2, the Peto method for statistical analysis. Results: Auxiliary to December 2010, preoperative chemotherapy study collected a total of 16 domestic and foreign has completed RCTs including 2594 patients meet the inclusion criteria for this study. Generally high quality of all trials, eight test random method explicitly, five trials blinded, five trials reported follow-up data. Accept the preoperative chemotherapy group and the surgery alone group and 1-year survival difference was not statistically significant (RR = 1.02; 95% CI: 0.95 ~~ 1.10; P = 0.54); 3-year survival rate (RR = 1.29; 95% CI: 1.13 to 1.47; P = 0.0001) and 5-year survival (RR = 1.31; 95% CI: 1.13 ~ 1.51; P = 0.0003) difference was statistically significant; total surgical resection rate (RR = 1.00; 95% CI: 0.95 to 1.04; P = 0.85) and surgical mortality (RR = 0.89; 95% CI: 0.64 ~ 1.23; P = 0.48) difference was not statistically significant. Preoperative adjuvant chemoradiation study collected a total of 13 domestic and foreign has completed RCTs including 1574 patients meet the inclusion criteria for this study. Preoperative adjuvant radiotherapy or chemotherapy with surgery alone group 1-year survival (RR = 1.09; 95% CI: 1.00 ~~ 1.18; P = 0.05), the 3-year survival rate (RR = 1.38; 95% CI: 1.19 to 1.61; P lt; 0.0001) and 5-year survival (RR = 1.34; 95% CI: 1.08 ~ 1.65; P = 0.007) difference was statistically significant; total resection rate (RR = 1.17; 95% CI: 1.07 ~~ 1.27 ; P = 0.0008) and surgical mortality (RR = 1.60; 95% CI: 1.03 ~ 2.49; P = 0.04) difference was also statistically significant; postoperative complications (RR = 1.09; 95% CI: 0.96 ~ 1.24; P = 0.20) and the difference was not statistically significant. Conclusion: The surgical removal of esophageal cancer underwent preoperative adjuvant chemotherapy did not increase the risk of surgery can improve long-term survival of patients with esophageal cancer; preoperative adjuvant radiotherapy or chemotherapy can improve long-term survival of patients with esophageal cancer and reduce tumor locoregional recurrence rate but may increase in surgery-related complications and mortality. This study suggests that preoperative auxiliary (put) chemotherapy is an effective method for the treatment of esophageal cancer, but can not be ignored preoperative neoadjuvant chemoradiotherapy treatment of esophageal cancer associated with increased risk of postoperative mortality. Auxiliary (put preoperative) chemotherapy program and the selection of new chemotherapy drugs deserves further study.

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CLC: > Medicine, health > Oncology > Gastrointestinal Cancer > Esophageal tumors
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