We searched for studies that explored patients with histologically confirmed-, resectable-, esophageal carcinoma who received either NICRT or NICT followed by surgery. The detailed search strategies are summarized in Supplementary Table 1. We searched PubMed, Web of Science, Embase, and Cochrane Central databases, as well as international conference abstracts from American Society of Clinical Oncology, European Society for Medical Oncology and American Association for Cancer Research, along with various other resources, until December 16, 2022. 2.1 Search strategy and eligibility criteria The present study was registered in the INPLASY (identifier: INPLASY2022120060). This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 ( 14). Therefore, this systematic review and meta-analysis was conducted to evaluate the outcomes of patients treated with either of two neoadjuvant immunotherapies – neoadjuvant immunotherapy combined with chemoradiotherapy (NICRT) and neoadjuvant immunochemotherapy (NICT) – compared with two traditional neoadjuvant therapies – neoadjuvant chemoradiotherapy (NCRT) and neoadjuvant chemotherapy (NCT). Several studies have documented benefits when immunotherapy is added to neoadjuvant therapy ( 10, 11) on the other hand, adding immunotherapy to neoadjuvant therapy increases the severity of toxic side effects ( 12, 13). However, it remains unclear whether adding immunotherapy therapy to preoperative neoadjuvant confers an overall benefit to patient outcomes when radical surgery is performed after neoadjuvant therapy. Immunotherapy has proven beneficial as a third-, second-, and even first-line treatment for patients with esophageal cancer. By rescuing the immune checkpoint pathway to resist carcinoma, the anti-tumor action of T cells is blocked by immune checkpoint blockade. Immunotherapy has become an effective treatment for many malignancies including esophageal cancer ( 7– 9). Nevertheless, the treatment efficacy for esophageal cancer remains poor, with a 5-year survival rate of approximately 20% ( 5, 6). Accordingly, the National Comprehensive Cancer Network guidelines recommend it as the standard therapy ( 4). The CROSS trial showed that neoadjuvant chemoradiation followed by surgical resection was more beneficial for esophageal cancer ( 3). Surgical resection has advocated for the treatment of early-stage esophageal cancer ( 2). Systematic Review Registration:, identifier INPLASY2022120060.Įsophageal cancer is the seventh most common malignant tumor and the sixth leading cause of cancer-related mortality worldwide ( 1). Adding immunotherapy to neoadjuvant therapy improved 1-year OS and DFS, with NICT having the highest rates compared to the other three modalities. There were no significant differences in the R0 rates among the four treatments. There were no significant differences among the four neoadjuvant treatments in terms of R0 rates.Ĭonclusions: Among the four neoadjuvant treatment modalities, NICRT and NCRT had the highest pCR and mPR rates. Neoadjuvant immunotherapy has a significant advantage over traditional neoadjuvant therapy in terms of 1-year OS and DFS, with NICT having better outcomes than any of the other three treatments. Both were better than NICT, with NCT showing the lowest response rate. We found no significant differences between NICRT and NCRT in pCR or mPR rates. Results: We included data from 5,034 patients from 86 studies published between 20. Outcomes included R0, pathological complete response (pCR), major pathological response (mPR), overall survival (OS) and disease-free survival (DFS) rates. Methods: We searched PubMed, Web of Science, Embase, and Cochrane Central databases, as well as international conference abstracts. However, it is uncertain whether adding immunotherapy to preoperative neoadjuvant therapy would improve patient outcomes when radical surgery is performed following neoadjuvant therapy. Summary background data: NCRT followed by surgical resection is recommended for patients with early-stage esophageal cancer. Objective: This systematic review and meta-analysis aimed to investigate the role of neoadjuvant immunochemotherapy with or without radiotherapy compared to traditional neoadjuvant therapies, without immunotherapy. Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.Hesong Wang Chunyang Song Xiaohan Zhao Wenzhao Deng Jing Dong Wenbin Shen *
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