Do Higher Radiation Doses with Concurrent Chemotherapy in the Definitive Treatment of Esophageal Cancer Improve Outcomes? A Meta-Analysis and Systematic Review
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.
基金:
Clinical Translational Research of Achievement in Tumor Field [162777114D]; Preoperative Concurrent Chemoradiotherapy for Potentially Resectable Adenocarcinoma of the Esophagogastric Junction (A-C); 2016 Beijing Hope Marathon Fund of China Cancer Foundation [LC2016W10]; Medical Science Research Key Projects of Hebei Provincial Department [ZD20140060]; Government Funding for Clinical and Scientific Research Capacity Building by Hebei Provincial Department of Finance [361006]
第一作者机构:[1]Hebei Med Univ, Hosp 4, Dept Radiotherapy, Shijiazhuang, Hebei, Peoples R China
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推荐引用方式(GB/T 7714):
Xiao Linlin,Czito Brian G.,Pang Qingsong,et al.Do Higher Radiation Doses with Concurrent Chemotherapy in the Definitive Treatment of Esophageal Cancer Improve Outcomes? A Meta-Analysis and Systematic Review[J].JOURNAL OF CANCER.2020,11(15):4605-4613.doi:10.7150/jca.44447.
APA:
Xiao, Linlin,Czito, Brian G.,Pang, Qingsong,Hui, Zhouguang,Jing, Shaowu...&Wang, Jun.(2020).Do Higher Radiation Doses with Concurrent Chemotherapy in the Definitive Treatment of Esophageal Cancer Improve Outcomes? A Meta-Analysis and Systematic Review.JOURNAL OF CANCER,11,(15)
MLA:
Xiao, Linlin,et al."Do Higher Radiation Doses with Concurrent Chemotherapy in the Definitive Treatment of Esophageal Cancer Improve Outcomes? A Meta-Analysis and Systematic Review".JOURNAL OF CANCER 11..15(2020):4605-4613