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Table 3 Randomized trials of surgery and postoperative radiotherapy (RT) versus surgery alone.

From: Neoadjuvant or adjuvant therapy for resectable esophageal cancer: a systematic review and meta-analysis

Study, year [Reference] Participants Number of patients Interventions Median Survival (Months) Survival Rate (%) Adverse Effects (Number of Patients)
      1 yr 2 yr 3 yr 4 yr 5 yr  
Fok et al. 1993 [27] 130 patients July 1986-Dec 1989 Hong Kong, single centre squamous cell adenocarcinoma excluded leaks, respiratory failure, poor performance, metastases 65 esophagectomy + 49–52.5 Gy postop RT 8.7 34 18 16 16 - gastritis, 6; ulcer, 17; tracheo-esophageal fistulae, 1; strictures, 6
   versus versus versus versus versus
   65 esophagectomy (Lewis-Tanner or transhiatal or sternal split) 15.2 65 25 21 16 - gastritis, 3; ulcer, 1; tracheo-esophageal fistulae, 0; strictures, 6
      Shorter survival with RT (p = 0.02). Better local control with RT (p = 0.06) but with more complications.  
Teniere et al. 1991 [28] 221 patients Dec 1979-Dec 1985 France, multi centre squamous cell distal 2/3 esophagus 102 esophagectomy + 45–55 Gy postop RT 18 68 50 27 24 21 minor, 18; major, 4; death, 1
   versus versus versus versus versus
   119 esophagectomy (transhiatal or right thoracotomy with stomach or colon interposition) 18 73 51 29 22 19 none reported
      No difference in survival (p-value not reported). Local or regional recurrence was lower with RT (70% versus 85%, p-value not reported).  
Fok* 1994 [5] 79 patients 1968–1981 Hong Kong, single centre Squamous cell middle 1/3 esophagus 42 esophagectomy (one or two stage) + 45–53 Gy postop RT 11 48 17 17 12 10 respiratory 25; postoperative deaths 3; leaks 11
   versus versus versus versus versus
   39 esophagectomy (right thoracotomy, left neck, and abdomen) 22 58 36 24 16 16 respiratory 15; postoperative deaths 3; leaks 7
      No difference in survival.  
Zieren et al. 1995 [29] 68 patients (did not accrue entire sample size 68/160) June 1988-Dec 1991 Germany, single centre squamous cell excluded cervical location, metastases, other cancers, previous treatment 33 esophagectomy + 55.8 Gy postop RT 14 57 29 22 - - tracheo-esophageal fistulae, 1; skin, 18; strictures, 2
   versus versus versus versus versus
   35 esophagectomy (transhiatal or right thoracotomy with stomach interposition) 13 53 31 20 - - strictures, 1
      No difference in survival (p-value not reported).  
Xiao et al. 2003 [47] 495 patients 220 Midplane dose of 50–60 Gy in 25–30 fractions over 5–6 weeks NR - - - - 41 NR
   versus versus versus versus  
   275 Surgery alone NR - - - - 32  
      p = 0.4474  
  1. Note: NR, not reported.
  2. *Patients randomized to four groups; data shown are for surgery + radiotherapy versus surgery alone.