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Do Higher Radiation Doses with Concurrent Chemotherapy in the Definitive Treatment of Esophageal Cancer Improve Outcomes? A Meta-Analysis and Systematic Review

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机构: [1]Hebei Med Univ, Hosp 4, Dept Radiotherapy, Shijiazhuang, Hebei, Peoples R China [2]Duke Univ, Dept Radiat Oncol, Durham, NC USA [3]Tianjin Med Univ Canc Inst & Hosp, Key Lab Canc Prevent & Therapy, Tianjins Clin Res Ctr Canc, Dept Radiotherapy,Natl Clin Res Ctr Canc, Tianjin, Peoples R China [4]Peking Union Med Coll, Dept Radiotherapy, Canc Inst & Hosp, Beijing, Peoples R China [5]Chinese Acad Med Sci, Beijing, Peoples R China
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关键词: definitive concurrent chemoradiotherapy dose escalation esophageal cancer esophageal squamous cell carcinoma radiation dose

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Background: To investigate the effects and safety profile of radiation dose escalation utilizing computerized tomography (CT) based radiotherapy techniques (including 3-Dimensional conformal radiotherapy, intensity-modulated radiotherapy and proton therapy) in the definitive treatment of patients with esophageal carcinoma (EC) with definitive concurrent chemoradiotherapy (dCCRT). Methods: All relevant studies utilizing CT-based radiation planning, comparing high-dose (>= 60 Gy) versus standard-dose (50.4 Gy) radiation for patients with EC were analyzed for this meta-analysis. Results: Eleven studies including 4946 patients met the inclusion criteria, with 96.5% of patients diagnosed with esophageal squamous cell carcinoma (ESCC). The high-dose group demonstrated a significant improvement in local-regional failure (LRF) (OR 2.199, 95% CI 1.487-3.253; P<0.001), two-year local-regional control (LRC) (OR 0.478, 95% CI 0.309-0.740; P=0.001), two-year overall survival (OS) (HR 0.744, 95% CI 0.657-0.843; P<0.001) and five-year OS (HR 0.683, 95% CI 0.561-0.831; P<0.001) rates relative to the standard-dose group. In addition, there was no difference in grade >= 3 radiation-related toxicities and treatment-related deaths between the groups. Conclusion: Under the premise of controlling the rate of toxicities, doses of >= 60 Gy in CT-based dCCRT of ESCC patients might improve locoregional control and ultimate survival compared to the standard-dose dCCRT. While our review supports a dose-escalation approach in these patients, multiple ongoing randomized trial initial and final reports are awaited to evaluate the effectiveness of this strategy.

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出版当年[2020]版:
大类 | 3 区 医学
小类 | 3 区 肿瘤学
最新[2025]版:
大类 | 3 区 医学
小类 | 4 区 肿瘤学
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出版当年[2020]版:
Q2 ONCOLOGY
最新[2023]版:
Q2 ONCOLOGY

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第一作者机构: [1]Hebei Med Univ, Hosp 4, Dept Radiotherapy, Shijiazhuang, Hebei, Peoples R China
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