Preoperation Radiotherapy Combined With Surgical Treatment Of Esophageal Cancer:a Meta-analysis

Objective At present, most researchers believe that preoperative radiotherapy combined with surgery in patients with esophageal cancer can reduce partial recurrence rate and lymph node metastasis rate, and improve surgical resection rate. It does not increase mortality rate and incidence rate of anastomotic leakage after operation. Whether preoperative radiotherapy can improve the long-term survival with esophageal cancer remains a controversial issue in recent years. Therefore, we assess the effectiveness and safety of preoperative radiotherapy combined with surgery for esophageal cancer by meta-analysis to provide high quality evidence of radiation therapy.Results At last,10RCTs (5English and1Chinese studies) including2,706patients were included in the meta-analysis. Among these studies, two studies mentioned randomized method, and only one study used the enveloped allocation concealment. None was done with blind method. The result showed that preoperative radiotherapy combined with surgery in esophageal cancer can improve the1-year overall survival [RR=1.17,95%CI (1.07,1.28),P=0.0004],5-year overall survival rates [RR=1.18,95%CI (1.01,1.37),P=0.03] and surgical resection rate [RR=1.08,95%CI (1.05,1.11),P<0.00001]. And it can reduce lymph node metastasis rate [RR=0.60,95%CI (0.43,0.84), P=0.003] and stump positive rate of residual cancer [RR=0.18,95%CI (0.08,0.41), P<0.0001]. However, there was no significant difference in both of3-year overall survival rates [RR=1.54,95%CI (0.97,2.45), P=0.07] and the incidence of postoperative anastomotic leakage [RR=0.74,95%CI (0.33,1.66), P=0.47].Conclusions Compare with surgery alone, preoperative radiotherapy combined with surgery in esophageal cancer can improve the1-year overall survival,5-year overall survival rates and surgical resection rate, as well as reducing lymph node metastasis rate and stump positive rate of residual cancer. However, there was no significant difference in3-year overall survival rates and the incidence of postoperative anastomotic leakage. We need large-scale high-quality randomized controlled, double-blind trials to update the significance of the combined treatment of preoperation radiotherapy combined with surgery.