Preoperative chemoradiotherapy and preoperative and/or perioperative chemotherapy for esophagogastric junction adenocarcinoma

The prognosis of patients with adenocarcinoma of the esophagus and esophagogastric junction (AEG) is poor. An individual patient data meta-analysis evaluated preoperative chemoradiotherapy (CRT) or preoperative and/or perioperative chemotherapy (CT) compared with surgery alone for AEG. In this network meta-analysis of 17 randomized studies with 2549 patients, both preoperative CRT (HR 0.75; 95% CrI 0.62-0.90) and preoperative and/or perioperative CT (0.78; 0.64-0.91) were associated with longer overall survival than surgery alone, while there was no significant overall survival difference between the two modalities (1.04; 0.83-1.28). Similarly, disease-free survival was longer for both modalities compared with surgery alone. Postoperative morbidity, but not mortality was more frequent after CRT plus surgery than after surgery alone. The authors conclude that both preoperative CRT and preoperative and/or perioperative CT were associated with longer survival than surgery alone among AEG patients.