Abstract
Background and objectivesRadiation Therapy Oncology Group (RTOG) 94–05 has demonstrated that higher dose radiation didn’t improve outcome of patients with esophageal cancer (EC). However, several retrospective studies showed that a higher dose radiation based on modern radiotherapy techniques could improve overall survival (OS) and local control rate (LCR) of patients with EC, especially esophageal squamous cell cancer (ESCC). As trials have provided updated and controversial data, we performed this updated meta-analysis to investigate whether high-dose (> = 60 Gy) radiotherapy in definitive concurrent chemo-radiotherapy (CCRT) could yield benefit compared to standard dose radiotherapy.MethodsA systematic literature search was carried out in the database of MEDLINE, PubMed and Embase. All studies published between 1 January 1990 and 31 December 2018 on the association between radiation dose and curative efficiency in EC were included in this meta-analysis. The hazard ratio (HR) was used to evaluate the time-to-event data employing RevMan version 5.3.ResultsEight articles with a total of 3736 patients were finally included. Results indicated that there was a significant benefit in favor of high dose radiotherapy (HD-RT) regarding OS (HR = 0.78, 95%CI: 0.72–0.84, p < 0.001; 2-year OS risk ratio (RR) = 1.25, 95%CI: 1.14–1.37, p < 0.001), progression-free survival (PFS) (P = 0.001, HR = 0.7, 95%CI: 0.57–0.87) and LRFS (P < 0.001, HR = 0.52, 95%CI: 0.36–0.74) .ConclusionsHD-RT (> = 60 Gy) based on modern radiotherapy techniques in definitive CCRT appears to improve OS, PFS amd LRFS compared to the SD-RT in patients with ESCC.
Highlights
Esophageal cancer (EC) is one of the most common malignant tumors and the fourth most common cause of cancer-related deaths worldwide [1, 2]
For patients with locally advanced inoperable disease or patients refused surgery, definitive concurrent chemoradiotherapy (CCRT) is recommended as a standard treatment modality based on the results of the Intergroup Radiation Therapy Oncology Group (RTOG)8501 which improved the local control (LC) and overall survival (OS) with concurrent chemo-radiotherapy (CCRT) compared with radiotherapy (RT) alone [5]
As several studies have indicated that a higher dose above 50.4Gy of CCRT could be safely administered without significant untoward effects and yield high probability of LC [9–11], a dose of 60.0 Gy or more has become a more popular dose of CCRT in Asian countries, where esophageal squamous cell cancer (ESCC) is the predominant histological type
Summary
Esophageal cancer (EC) is one of the most common malignant tumors and the fourth most common cause of cancer-related deaths worldwide [1, 2]. For patients with locally advanced inoperable disease or patients refused surgery, definitive concurrent chemoradiotherapy (CCRT) is recommended as a standard treatment modality based on the results of the Intergroup Radiation Therapy Oncology Group (RTOG)8501 which improved the local control (LC) and overall survival (OS) with CCRT compared with radiotherapy (RT) alone [5]. Radiation Therapy Oncology Group (RTOG) 94–05 has demonstrated that higher dose radiation didn’t improve outcome of patients with esophageal cancer (EC). Several retrospective studies showed that a higher dose radiation based on modern radiotherapy techniques could improve overall survival (OS) and local control rate (LCR) of patients with EC, especially esophageal squamous cell cancer (ESCC). As trials have provided updated and controversial data, we performed this updated meta-analysis to investigate whether high-dose (> = 60 Gy) radiotherapy in definitive concurrent chemo-radiotherapy (CCRT) could yield benefit compared to standard dose radiotherapy
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