| Objective:We aimed to conduct a meta-analysis of randomized clinical trials to evaluate the efficacy and safety of chemoradiotherapy for resectable gastric cancer.Material and Methods:We electronically and manually searched randomized controlled trials (RCTS) involving patients with resectable gastric cancer on PubMed, EMBASE, Cochrane library of clinical trials, Chinese National Knowledge Infrastructure, WanFang Database and WeiPu Database. The compared interventions included chemoradiation versus chemotherapy, or chemoradiation versus surgery alone. The primary outcomes of interest were relative risk on overall survival and disease-free survival. The second outcomes include risk difference on grade 3 or 4 toxicity. Both fixed-and random-effects models were used to calculate the summary risk estimates.Results:Twenty RCTs involving 2,741 participants were included in this meta-analysis. Two RCTs about neoadjuvant chemoradiotherapy, two RCTs about adjuvant chemoradiotherapy and surgery alone and 16 RCTs conducted on D2 surgery including 8 RCTs about adjuvant chemoradiotherapy and adjuvant chemotherapy. Our results showed that postoperative chemoradiotherapy significantly improved 3-year survival (risk ratio(RR) 1.33,95% CI[1.21,1.47]) and 5-year survival (RR 1.16,95% CI[1.01,1.33]) when compared to chemotherapy. Chemoradiation after D2 resection was associated with a significant increase in 3-year disease-free survival (RR 1.15, 95% CI[1.05,1.47]) and 5-year disease-free survival (RR 1.20,95% CI[1.01,1.42]). However, the improvement of 5-year survival was non-significant (RR 1.13, 95%CI[0.97,1.32]). Postoperative chemoradiation also improved 3-year survival (RR 1.21,95% CI[1.02,1.45]) and 3-year disease-free survival (RR 1.53,95% CI[1.24, 1.88]),when compared with surgery alone. Neoadjuvant chemoradiotherapy showed great improvement in 3-year survival (risk ratio(RR 1.56,95% CI:1.03,2.36) and 5-year survival (RR 1.85,95% CI[1.09,3.16]) in adenocarcinoma of esophagogastric junction treatment. The main grade 3 or 4 toxicities were equivalent between the two groups, except for 3 or 4 grade neutropenia (RR 1.29,95% CI[1.09, 1.52])Conclusion:In patients with resectable gastric carcinoma, adjuvant chemoradiotherapy significantly increase the 3-year and 5-year survival. Adjuvant chemoradiation improves 3-year survival and 3-year disease-free survival, when compared with surgery alone. Neoadjuvant chemoradiotherapy may improve 3-year survival and 5-year survival in adenocarcinoma of esophagogastric junction. The main grade 3 or 4 toxicities were equivalent between the two groups, except for 3 or 4 grade neutropenia. It remains appropriate to design trials testing neoadjuvant chemoradiothrapy for gastric cancer. |
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