| Obsjiective To assess the effects and safety of neoadjuvant chomeradiother -apy for esophageal cancerMethods We searched The Cochrane Central Register of Controlled Trials (CENTRAL),PubMed,EMbase,CBMdisc,CNKI,VIP and web site of some clinical trials.Relevant journals were also hand searched to september 2009.We collected randomized controlled trials(RCT) comparing neoadjuvant chemoradiotherapy with surgery alone for esophageal caner esophageal cancer .Study selection and quality assessment,data extraction and analyses were undertaken by two reviewers independently according to the Cochrane Handbook for Systematic Reviews of interventions.Meta-analyses were also performed.Results 10 RCTs involving 1226 eligible patients were included,which contain 619 assigned to neoadjuvant chomeradiotherapy and 607 assigned to surgery alone.The results of neoadjuvant chomeradiotherapy comparing with surgery alone indicate:(1) for 1 year survial,there is no statistical significance (RR= 1.07,95%CI0.98-1.17, p=0.13); 3,5 year surival can be improved and there is statistical significance (RR=1.36, 95%CI1.0 7-1.74, p=0.01), (RR=1.52,95%CI1.07-2.41, p=0.02)(2)for postoperative complications,there is no statistical significance, (RR=1.06,95% CI0.95-1.19, p=0.28). (3) Postoperative mortality rate can be raised and there is statistical significance (RR=1.66,95 CI1.07-2.57, p=0.02).using subgroup analysis,for radiation segmentation dose < 3.0 Gy of clinical trials,postoperative mortality rate has no statistical significance(RR=1.31,95% CI0.80-2.15,p=0.29). however, for radiation segmentation dose > 3.0Gy,there is statistical significance (p =0.012).Conclusion comparing with surgery alone, neoadjuvant chomeradiother–apy can not improve 1 year survial rate but can improve 3,5 year survial rate meanwhile,this intervention can improve surgical resection rate and ruduce cancer recurrence rate;this intervention don not improve surgical complications rate but improve postoperative mortality rate, subgroup analysis indicate radiation segmentation dose < 3.0 Gy don't improve postoperative mortality rate while radiation segmentation dose>3.0Gy can improve postoperative mortality rate. in view of this systematic review Including study which existed a varity of bias. Conseqently,reasonable and strict design,large sample and multi central RCT is need for guiding clinical practice. |
