1: Ann Oncol 1996 Apr;7(4):355-9

Chemotherapy for carcinoma of the esophagus: a comparison of evidence from
meta-analyses of randomized trials and of historical control studies.

Bhansali MS, Vaidya JS, Bhatt RG, Patil PK, Badwe RA, Desai PB

Department of Thoracic Oncology, Tata Memorial Centre, Bombay, India.

BACKGROUND: Chemotherapy (CT) has been used as an adjunct to local treatment
(surgery or radiotherapy) in esophageal carcinoma. A meta-analysis of all
published randomized clinical trials and historical control studies which have
used cisplatinum-based combination CT was carried out to asses the effect of
chemotherapy on survival for esophageal cancer. MATERIALS AND METHODS: A
computer-based literature search was performed for the period from January 1988
to March 1995 using the index terms "Esophageal neoplasms' and "Chemotherapy'.
The frame of reference was further narrowed to include only cisplatinum-based
combination chemotherapy. Twelve randomized clinical trials (RCT) and eight
historical control (HC) studies were included in the meta-analysis. RESULTS: In
the overview of HC studies a highly significant reduction in odds of death with
CT was observed (68% +/- 8% OR = 0.32, 95% CI 0.24-0.42). On the other hand, the
overview of RCTs showed a relative reduction in odds of death for the CT group
of 4.2% +/- 23.7% (OR = 0.96, 95% CI 0.75-1.22). CONCLUSIONS: There was a gross
overestimation of treatment effect in the studies using HC as compared to RCTs,
despite the use of cisplatinum-based chemotherapy in both groups. The
meta-analysis of RCTs reveal no significant survival benefit from
cisplatinum-based adjuvant/neoadjuvant chemotherapy in esophageal cancer.

Publication Types:
Meta-analysis

PMID: 8805926, UI: 96399433