Abstract:
Esophageal cancer (EC) is a leading cause of cancer morbidity and mortality in Africa.
Despite the high burden of disease, optimal management strategies for EC in
resource-constrained settings have yet to be established. This systematic review
evaluates the literature on treatments for EC throughout Africa and compares the
efficacy and safety of varying treatment strategies in this context (PROSPERO
CRD42017071546). PubMed, Embase and African Index Medicus were searched for
studies published on treatment strategies for EC in Africa from 1980 to 2020.
Searches were supplemented by examining bibliographies of included studies and relevant
conference proceedings. Methodological quality/risk of bias was assessed
using the Cochrane Risk-of-Bias tool and the Newcastle-Ottawa Scale. Forty-six
studies were included. Case series constituted the majority of studies: 13 were case
series reporting on outcomes of esophagectomies, 17 on palliative luminal or surgical
interventions, four on radiotherapy and three on concurrent chemoradiation. Nine
randomized controlled trials were identified, of which four prospectively compared
different treatment modalities (one investigating radiotherapy vs chemoradiation,
three evaluating rigid plastic stents vs other treatments). This review summarizes the
research on EC treatments in Africa published over the last four decades and outlines
critical gaps in knowledge related to management in this context. Areas in need of
further research include (a) evaluation of the safety and efficacy of neoadjuvant therapy
in patients with locally advanced disease; (b) strategies to improve long-term survival
in patients treated with definitive chemoradiation; and (c) the comparative
effectiveness of modern palliative interventions, focusing on quality of life and survival
as outcome measures
