Randomized controlled trials of postoperative chemoradiotherapy versus chemotherapy alone in patients with gastric cancer: a meta-analysis

Abstract

Objective To compare the efficacy and safety between postoperative chemoradiotherapy and postoperative chemotherapy alone in patients with gastric cancer by a meta-analysis of randomized controlled trials (RCTs).Methods Chinese Scientific Journal Full-Text Database (January 1979-June 2013),VIP (January 1989-June 2013),Chinese Biomedical Literature Database (January 1978-June 2013),Cochrane Library (Issue 6,2013),PubMed (January 1966-June 2013),and EMBASE (January 1974-June 2013) were searched to identify RCTs of postoperative chemoradiotherapy versus chemotherapy alone in patients with gastric cancer.The obtained data were analyzed using RevMan 5.2 and Stata 12.The difference between two groups was estimated by calculating the risk ratio (RR) with 95％ confidence interval (CI).Results A total of 1 143 patients from 11 RCTs were included in the meta-analysis according to the inclusion and exclusion criteria.Our results showed that postoperative chemoradiotherapy significantly increased 1-,2-,and 3-year overall survival rates (RR =1.20,95％ CI=1.10-1.30,P=0.00; RR =1.34,95％ CI=1.16-1.56,P=0.00; RR =2.62,95％ CI=1.72-3.97,P=0.00) and 3-and 5-year disease-free survival rates (RR =1.10,95 ％ CI =1.00-1.21,P =0.04; RR =1.27,95％ CI =1.02-1.60,P =0.04).The incidence of grade 3 or 4 gastrointestinal tract reactions,liver function impairment,bone marrow suppression,and hand-foot syndrome was low and showed little difference between two groups (P =0.03-0.78).Conclusions Postoperative chemoradiotherapy can prolong the survival of patients with gastric cancer,and the patients have good tolerance to chemotherapy drugs. Key words: Stomach neoplasms/combined modality therapy; Postoperative radiochemotherapy; Postoperative chemotherapy; Randomized controlled trial; Meta-analysis