What is the best neoadjuvant regimen prior to oesophagectomy: Chemotherapy or chemoradiotherapy?
What is the best neoadjuvant regimen prior to oesophagectomy: Chemotherapy or chemoradiotherapy?
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DOI：
10.1016/j.ijsu.2013.12.005
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发表时间：
2014-01-01
影响因子：
15.3
通讯作者：
Griffiths, Ewen A.
中科院分区：
文献类型：
--
作者：
Hamilton, Emma;Vohra, Ravinder S.;Griffiths, Ewen A.
上胃肠道手术的最佳证据主题是根据结构化的方案编写的。问题是可切除食道癌患者的新辅助化疗(CT)或放化疗(CRT)是否与最佳临床结果相关。共检索到1115篇文献，其中5篇文献被确定为回答临床问题，包括2个随机对照试验(II级)、2个前瞻性系列(II级)和1个回顾性研究(III级)。证据表明，CRT显着提高病理完全应答率，在一些研究中，这与显着的生存优势有关。这是以增加围手术期发病率和死亡率为代价的。然而，这两项随机研究都明显不足，而且似乎没有标准的CT或CRT方案在任何研究中使用。因此，对于新辅助的CT和CRT哪个更有益，仍然存在争议，这导致了全球各地的实践差异。目前正在进行两项随机对照试验，有望回答这一重要的临床问题。(C)2013 Surgical Associates Ltd.由爱思唯尔有限公司出版。版权所有。
A best evidence topic in upper gastrointestinal surgery was written according to a structured protocol. The question addressed was whether neoadjuvant chemotherapy (CT) or chemoradiotherapy (CRT) in patients with resectable oesophageal cancer is associated with the best clinical outcome. 1115 papers were found of which 5 papers were identified to answer the clinical question including 2 randomised controlled trials (level II), 2 prospective series (level II) and one retrospective study (level III). The evidence suggests CRT significantly increases the pathological complete response rate and in some studies this is associated with a significant survival advantage. This is at the cost of an increase in peri-operative morbidity and mortality. However, both randomised studies were significantly underpowered and no standard CT or CRT regimen appears to have been used in any study. Therefore, controversy still exists as to whether neoadjuvant CT or CRT is more beneficial and this has lead to variation in practice around the globe. Two randomised controlled trials are currently underway which will hopefully answer this important clinical question. (C) 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.