PREOPERATIVE RADIOTHERAPY IN ESOPHAGEAL-CARCINOMA - A METAANALYSIS USING INDIVIDUAL PATIENT DATA (ESOPHAGEAL CANCER COLLABORATIVE GROUP)

Purpose: The existing randomized evidence has failed to conclusively d emonstrate the benefit or otherwise of preoperative radiotherapy in tr eating patients with potentially resectable esophageal carcinoma. This meta-analysis aimed to assess whether there is benefit from adding ra diotherapy prior to surgery. Methods and Materials: This quantitative meta-analysis included updated individual patient data from all proper ly randomized trials (published or unpublished) comprising 1147 patien ts (971 deaths) from five randomized trials. Results: With a median fo llow-up of 9 years, the hazard ratio (HR) of 0.89 (95% CI 0.78-1.01) s uggests an overall reduction in the risk of death of 11% and an absolu te survival benefit of 3% at 2 years and 4% at 5 years. This result is not conventionally statistically significant (p = 0.062). No clear di fferences in the size of the effect by sex, age, or tumor location wer e apparent. Conclusion: Based on existing trials, there was no clear e vidence that preoperative radiotherapy improves the survival of patien ts with potentially resectable esophageal cancer. These results indica te that if such preoperative radiotherapy regimens do improve survival , then the effect is likely to be modest with an absolute improvement in survival of around 3 to 4%. Trials or a meta-analysis of around 200 0 patients would be needed to reliably detect such an improvement (15- ->20%). (C) 1998 Elsevier Science Inc.