PROSPERO

International prospective register of systematic reviews

Optimal management of esophageal cancer in Africa: a systematic review of treatment

strategies
Geoffrey Buckle, Katherine Van Loon

Citation
Geoffrey Buckle, Katherine Van Loon. Optimal management of esophageal cancer in Africa: a
systematic review of treatment strategies. PROSPERO 2017 CRD42017071546 Available from:
http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017071546

Review question
To identify all studies reporting treatment strategies for esophageal cancer across the continent of Africa,
including chemotherapy, radiotherapy, surgical/procedural interventions, as well as combined treatment
modalities.
To assess and compare the efficacy and safety of varying treatment strategies for esophageal cancer in
Africa.
To highlight research priorities for esophageal cancer treatment in Africa.

Searches
The systematic review will be conducted according to PRISMA guidelines through electronic and manual
searches of relevant databases as well as conference proceedings. The literature search will be carried out
using MeSH terms related to esophageal cancer and Africa. Reference list of pertinent review articles as well
as original research papers identified will also be manually screened to identify additional relevant citations.
The following electronic databases will be searched through database-specific search strategies:
– PubMed, Embase and African Index Medicus.
Additionally, titles/abstracts will be reviewed from the following conferences when available:
– Consortium of Global Health (CUGH) Annual Conference
– International Union for Cancer Control’s (IUCC) World Cancer Congress
– World Organization for Special Studies on Diseases of the Esophagus (OESO) World Congress
– American Association for Cancer Research (AACR) Annual Meeting
– National Cancer Institute’s (NCI) Symposium for Global Cancer Research Annual Meeting
– African Organization for Research and Training in Cancer (AORTIC) International Conference on Cancer in
Africa.
Findings from these databases, conferences and manual review of reference lists will be limited to those
texts written or translated to English, and available in abstract and/or full manuscript form. The search will be
restricted to research published 1980 to present.

Types of study to be included

• All cohort, randomized-controlled trials, case series and case-control studies including treatment data are
eligible to be included in this review.• Commentaries, letters and editorials will be included if original data is
presented.Exclusion criteria: • Abstracts/papers reporting epidemiological data without treatment
information, including those investigating etiological risk factors or incidence/prevalence data.• Case
reports.• Studies not written or translated to English.• Studies published earlier than 1980.• If multiple
citations report data on the same study population, the more recent and complete citation will be
preferentially included.

Condition or domain being studied

Esophageal malignancy.

Participants/population
Adult patients (>18 years of age) with a diagnosis of esophageal cancer receiving any form of anti-cancer

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International prospective register of systematic reviews

therapy, including palliative treatment, in studies conducted in an African country or includes an enumerable
subset of subjects enrolled in an African country. There will be no limitation on staging or prior therapy.

Intervention(s), exposure(s)
All chemotherapeutic agents.
Radiotherapy (including external-beam radiotherapy, itraluminal brachytherapy and varying fractionated
doses).
Any procedural or surgical interventions used as a treatment strategy in esophageal cancer (bypass surgery,
esophagectomy, laser, intubation, stenting techniques, dilation, among others).
All multimodal treatment strategies.

Comparator(s)/control
No treatment control for this review.

Primary outcome(s)
Overall survival.
Dysphagia score.
Dysphagia-free survival rate.

Secondary outcome(s)
Quality of life measures.
Treatment-related mortality.
Treatment abandonment.
Disease-free survival.
Rate of relapse.
Rate of progressive disease.
Event-free survival.
Adverse events.

Data extraction (selection and coding)

Database-specific search terms will be used to abstract titles from the 3 databases, PubMed, African Index
Medicus and Embase. A single reviewer (GB) will screen all titles/abstracts resulting from this search against
the inclusion and exclusion criteria. For those titles/abstracts that appear to meet criteria for inclusion, full
text will be reviewed for eligibility if available. If no full text is available through the databases, attempts will
be made to contact authors as well as journal editors to obtain full text publications. For full text articles that
meet eligibility criteria, reference lists will be manually reviewed to identify any additional relevant titles for
inclusion.
For conferences, efforts will be made to electronically search any available online archives for titles/abstracts
that meet eligibility criteria. For those conferences without online databases, we will attempt to download any
scientific programming, abstract booklet or conference proceeding if publically available online to manually
search titles/abstracts. If titles/abstracts are not publically available (including more recent or remote
conferences) we will contact conference organizers to obtain any materials that include archived
titles/abstracts. Throughout the screening process, reasons for excluding titles/abstracts, as well as full text
will be recorded.
The following data will be collected using a pre-designed data extraction form: first author, year of
publication, journal or conference, design of study, sources of funding, number of subjects, age, sex, HIV
status, setting, country, study duration (and years), diagnostic criteria, histological diagnosis, staging,
interventions, prior treatment (if available) and outcomes, including overall survival, dysphagia score or
dysphagia-free survival rate, quality of life measures, treatment-related mortality, treatment abandonment,
disease-free survival, rate of relapse, rate of progressive disease, event-free survival, adverse events, as
well as subjects lost to follow up, if reported. Information will also be collected for the assessment of the risk
of bias. We will attempt to contact study authors to pursue any relevant data not fully described in the
published abstract/manuscript.

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Risk of bias (quality) assessment

The methodological quality/risk of bias will be assessed in included studies using two tools. Randomized-
control trials (RCTs) will be assessed using the Cochrane Risk of Bias tool. Non-randomized studies of
interventions, including observational cohorts, retrospective case series and case-controls, will be assessed
using the Newcastle-Ottawa Scale.

Strategy for data synthesis

Given the paucity of data on esophageal cancer in resource-limited settings, particularly in Africa, the primary
objective of this study will be to offer a narrative/descriptive synthesis of existing management strategies and
their evidence base in this context. We suspect that a quantitative analytic strategy, including a meta-
analysis, will be precluded by the limited number of studies, small number of participants in many of the
trials, and the variety of outcomes measured across many different treatment modalities and combinations
trialed previously.

Analysis of subgroups or subsets

None planned.

Contact details for further information

Geoffrey Buckle
gcbuckle@gmail.com

Organisational affiliation of the review

University of California, San Francisco (UCSF)
www.ucsf.edu

Review team members and their organisational affiliations

Dr Geoffrey Buckle. University of California, San Francisco
Dr Katherine Van Loon. University of California, San Francisco

Anticipated or actual start date

07 July 2017

Anticipated completion date

01 December 2017

Funding sources/sponsors
None

Conflicts of interest
None known

Language
English

Country
United States of America

Stage of review
Review_Ongoing

Subject index terms status

Subject indexing assigned by CRD

Subject index terms

Africa; Disease Management; Esophageal Neoplasms; Esophagoscopy; Humans

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International prospective register of systematic reviews

Date of registration in PROSPERO

07 July 2017

Date of publication of this version

07 July 2017

Details of any existing review of the same topic by the same authors
Stage of review at time of this submission

Stage Started Completed

Preliminary searches Yes No
Piloting of the study selection process No No

Formal screening of search results against eligibility criteria No No

Data extraction No No
Risk of bias (quality) assessment No No

Data analysis No No

Versions
07 July 2017

PROSPERO
This information has been provided by the named contact for this review. CRD has accepted this information in good
faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration
record, any associated files or external websites.

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