Editor—The back page of the BMJ is one of the most widely read of the entire journal. I was therefore disappointed to read Minerva’s review1 of a paper in Archives of Surgery about the management of oesophageal cancer.2 The statements that she made could not be justified on the basis of the results of this work.
The study in question was a retrospective audit of neoadjuvant chemoradiation for operable oesophageal cancer of various histologies. It was non-randomised, non-standardised radiotherapy doses were given, and data were not collected prospectively. Quality of life was not measured. The main conclusion was that median survival time was not improved by the chemoradiation when compared with results from other studies.
This report has major methodological flaws. The dangers of overinterpreting such results should be obvious to all who try to practise evidence based medicine, which relies on only best available evidence. This generally means prospective randomised trials, of which at least three exist; all show measureable benefits for neoadjuvant chemoradiation.3–5 Clearly, further randomised studies need to be performed to determine the precise role of combined modality treatment in this disease, but such negative and misinformed reporting will not encourage recruitment.
Making dogmatic statements about end points that were not even measured (in this case quality of life) does a great disservice to the BMJ. I would implore Minerva to be more careful in future when reviewing retrospective audits, which clearly do not have the scientific robustness of randomised trials.
References
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