For patients with resectable esophageal and esophagogastric junction cancers, neoadjuvant and adjuvant radiotherapy with or without chemotherapy is widely used to improve the effect of surgery. This study is to evaluate the effect of radiotherapy adding to surgery and identify the optimized treatment model. According to pre-specified searching strategy and inclusion/exclusion criteria, we systematically screened electronic databases (PubMed, Embase and Cochrane Library) for relevant studies up to February 2020. Only phase II and III randomized controlled trials comparing the following treatments were included: surgery alone, surgery preceded by neoadjuvant radiotherapy (NRT) or neoadjuvant chemoradiotherapy (NCRT), surgery followed by adjuvant radiotherapy (ART) or adjuvant chemoradiotherapy (ACRT). Overall survival (OS) was identified as the measurement of effectiveness. A network meta-analysis was conducted to synthesize the evidence under the Bayesian framework. The relative effects of all possible comparisons were made. Ranking analysis was performed to support the decision in clinical practice. Fourteen eligible trials with 2904 patients were included and 10 comparisons were generated. The results were shown in table 1. Compared with surgery alone, only NCRT showed favorable OS with significant difference (hazard ratio (HR) 0.75, 95% credible interval 0.65-0.87), while NRT (HR 0.76, 0.43-1.31), ACRT (HR 0.74, 0.49-1.12) and ART (HR 0.9, 0.67-1.22) provided no significant survival advantage. Ranking analysis showed that the surface under the cumulative ranking curve (SUCRA) value in NCRT was 0.79, which was the highest among all five treatments, followed by ACRT (0.74), NRT (0.66), ART (0.41), and surgery alone (0.14). For resectable esophageal and esophagogastric junction cancers, NCRT may be the optimal strategy, while NRT or ART or ACRT may not improve OS compared with surgery alone. Table 1. Pooled hazard ratios (95% credible intervals) for overall survival in the network meta-analysis.Abstract 3531; TableNCRT_SNRT_SSS_ACRTS_ARTNCRT_SNCRT_S1 (0.56, 1.75)1.33 (1.15, 1.54)0.98 (0.65, 1.5)1.19 (0.86, 1.68)NRT_S1(0.57, 1.78)NRT_S1.32 (0.76, 2.34)0.97 (0.49, 2)1.19 (0.64, 2.3)S0.75 (0.65, 0.87)0.76 (0.43, 1.31)S0.74 (0.49, 1.12)0.9 (0.67, 1.22)S_ACRT1.02 (0.67, 1.53)1.03 (0.5, 2.02)1.35 (0.89, 2.04)S_ACRT1.22 (0.74, 2)S_ART0.84 (0.6, 1.16)0.84 (0.43, 1.57)1.12 (0.82, 1.5)0.82 (0.5, 1.36)S_ART Open table in a new tab