PRE-OPERATIVE CHEMO/RADIOTHERAPY FOR OESOPHAGEAL CANCER: SHORT TERM COST VERSUS LONG TERM BENEFIT

Oesophageal cancer continues to have an awful prognosis with a five year survival of only 10%. Attempts to improve the results of surgery by pre-operative chemotherapy or radiotherapy on their own has proved largely unsuccessful and trials of combined chemo/radiotherapy (CRT) have yielded conflicting results. This month we publish a meta-analysis of six randomised controlled trials [see page 925] which include data from 764 patients and show that pre-operative CRT improved survival at three years with an Odds Ratio of 0.5 (0.31 – 0.93). Part of the benefit relates to a down staging effect which is achieved by CRT with an odds ratio of 0.43 (0.26 – 0.72). Post operative adverse events were frequent with both CRT and surgery alone (39% versus 34%). However, the risk of dying within 90 days of surgery was increase by pre-operative CRT with an odds ratio of 2.1 (1.18 – 3.7). While demonstrating the benefit of CRT this meta-analysis also forces us to define in …