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Chemotherapy for metastatic carcinoma of the esophagus and gastro‐esophageal junction

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Abstract

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Background

More than 50% of patients with esophageal cancer have metastatic disease at presentation. The use of chemotherapy for this patient group is increasing with the intention of local and distant tumor control, improving quality of life and prolongation of survival.

Objectives

To assess the effectiveness of a) chemotherapy versus best supportive care or b) different chemotherapy regimes against each other, in metastatic esophageal carcinoma.

Search methods

Searches were conducted on the Cochrane Central register of Controlled Trials ‐ CENTRAL (which includes the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register) on The Cochrane Library (Issue 1 2004) MEDLINE (1966 to February 2004), EMBASE (1980 to February 2004) and Cancerlit. Reference lists from trials selected by electronic searching were handsearched to identify further relevant trials. Published abstracts from conference proceedings from the United European Gastroenterology Week (published in Gut) and Digestive Disease Week (published in Gastroenterology) were handsearched. The search was updated in February 2005 and February 2006. Members of the Cochrane UGPD Group, and experts in the field were contacted and asked to provide details of outstanding clinical trials and any relevant unpublished materials

Selection criteria

Randomized controlled trials comparing chemotherapy versus best supportive care, or different chemotherapy regimes against each other in patients with metastatic carcinoma of the esophagus or gastro‐esophageal junction.

Data collection and analysis

Two authors (MYVH/EJK) extracted data and assessed trial quality. Study authors were contacted to obtain subgroup results of patients with metastatic esophageal carcinoma.

Main results

Only two RCTs with a total of 42 participants compared chemotherapy with best supportive care for metastatic esophageal cancer. No survival benefit was shown for chemotherapy treatment in these RCTs. Five RCTs with a total of 1242 participants compared different chemotherapy regimes. Due to variation in patient population and chemotherapy regimes, it was not possible to perform a formal pooled analysis. There was no consistent benefit of any specific chemotherapy regimen.

Authors' conclusions

There is a need for well designed, adequately powered, phase III trials comparing chemotherapy versus best supportive care for patients with metastatic esophageal cancer. Chemotherapy agents with promising response rates and tolerable toxicity are cisplatin, 5‐fluorouracil (5‐FU), paclitaxel and antracyclins. Future trials comparing palliative treatment modalities should assess quality of life with validated quality of life measures.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Plain language summary

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Chemotherapy for metastatic (spread to other parts of the body) cancer which originates in the esophagus

Esophageal cancer is the eighth most common cancer, and has a high mortality. For many patients the disease has already spread to other parts of the body before esophageal cancer is diagnosed and a cure is not possible. Chemotherapy is increasingly being used for patients with metastatic disease aiming at control of tumor growth and prolongation of survival. This review of two trials with 42 participants shows that although the results of chemotherapy are promising, is has not yet been proven that such therapy prolongs survival and/or improves quality of life of patients with metastatic esophageal cancer. This means that further research is needed before chemotherapy can be considered as standard care in this setting