Radiotherapy versus surgery within multimodality protocols for XXXX --a meta-analysis of the randomized trials.

@entity1 @entity5 @entity1721 @entity1544 @entity418 @entity204
During recent years, the curative potential of radiotherapy versus surgery for @entity418 was investigated in randomized trials. A PubMED  , Medline  , and Web of Science   search identified six randomized studies comparing definitive (chemo-) radiotherapy with either surgery alone or surgery+/-induction treatment for @entity1 (n=929) with potentially resectable, mainly thoracic squamous cell (810/929 pts.) @entity418 . In three of the studies (440 pts.), resection alone was planned in the surgery arm, in three others induction chemoradiotherapy up to a total dose of 30-46 Gy followed by resection was scheduled (489 pts.). In the definitive radiation arms (+/-chemotherapy, conservative arm) total radiation doses of 45-71 Gy with differing fractionation schedules were planned. Summary hazard ratios for survival, loco-regional control and treatment related mortality were calculated from intent-to-treat data. Overall survival was equivalent between surgery and definitive chemoradiotherapy (hazard ratio (HR) 0.98 [95% CI 0.8-1.2, p=0.84]). There was a trend to more @entity5 related @entity204 in the definitive radiation+/-chemotherapy arms (HR 1.19 [0.98-1.44], p=0.07), predominantly due to a higher risk of loco-regional progression (HR 1.54 [1.2-1.98], p=0.0007) but treatment related mortality was lower in the conservative arms (HR 0.16 [0-0.89], p=0.001). Protocol compliance was better in the conservative arms. A high concurrent risk of distant metastases (HR 0.72 [0.52-1.01], p=0.06) worsens the @entity5 specific survival of the loco-regionally controlled, resected @entity1 with @entity1544 . The similar outcome in survival suggests that the safer approach of radiochemotherapy is a reasonable choice especially in comorbid @entity1 with @entity1721 .
