Annals of Oncology 7:355-359, 1996
© 1996 European Society for Medical Oncology
research-article |
Chemotherapy for carcinoma of the esophagus: A comparison of evidence from meta-analyses of randomized trials and of historical control studies
Department of Thoracic Oncology Tata Memorial Centre, Bombay, India
Correspondence to: Dr. R.A. Badwe Assistant Surgeon Dept. of Thoracic Oncology Dr. Ernest Borges Marg, Parel Bombay 400012, 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 over view 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.
chemotherapy, historical controls, oesophageal neoplasms, randomized controlled trials
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