Effects of Local Treatment in Combination with Systemic Therapy for Advanced Esophageal Cancer: A Systematic Review and Meta-Analysis

Purpose Initial studies investigating the combination of local and systemic treatments in advanced esophageal cancer (EC) have conflicting conclusions regarding survival benefits. The object of this systematic review and meta-analysis is to assess the efficacy of addition of local therapy to systemic treatments in patients with advanced EC. Methods and materials A systematic literature search was conducted in PubMed, EMBASE, and CENTRAL databases. Key eligibility criteria included studies that enrolled patients with histologically confirmed EC or esophagogastric junction cancer (EGJC) with metastasis or recurrence and compared survival benefits between the combined local and systemic treatment group and the systemic treatment alone group. Survival outcomes, represented by hazard ratios (HRs) of progression-free survival (PFS) and overall survival (OS), were pooled using a random-effect model. The MINORS score was adopted for quality assessment. Risk of bias was statistically examined by Begg's and Egger's tests. Results A total of 1 randomized controlled trial (RCT) and 10 qualified retrospective studies including 14489 patients were identified. Addition of local therapy to systemic treatment significantly improved PFS (HR 0.52, 95% CI 0.37–0.73, p < 0.001) and OS (HR 0.69, 95% CI 0.58–0.81, p < 0.0001) compared with systemic treatment alone. The subgroup analysis revealed that combined local and systemic treatment had significant survival advantage in both patients with oligometastasis (PFS: HR 0.45, 95% CI 0.31–0.64, p < 0.0001); OS: HR 0.62, 95% CI 0.48–0.79, p < 0.0001) and recurrence (OS: HR 0.55, 95% CI 0.37–0.81, p = 0.002). Conclusions In conclusion, addition of local treatment to systemic therapy can improve survival in patients with advanced esophageal cancer, particularly in those with oligometastasis or recurrent diseases.