Abstract
BackgroundRadiation or radiochemotherapy is a common adjuvant therapy for gastric cancer. Intensity-modulated radiation therapy (IMRT) has been demonstrated to provide better dose conformity, allowing dose escalation and/or reduction of normal tissue exposure compared with three-dimensional conformal radiation treatment (3D-CRT). However, the efficacy of IMRT and 3D-CRT in gastric cancer remains controversial. This study aimed to compare the efficacy and safety of IMRT with those of 3D-CRT in treating patients with gastric cancer through conducting a meta-analysis of 3-year survival rates [overall survival (OS) and disease-free survival (DFS)], local control rates, and toxic event rates.MethodsEmbase, PubMed, the Cochrane Library, and clinical trial databases were searched to identify the clinical trials of IMRT versus 3D-CRT for treating patients with gastric cancer. The obtained data of survival and safety were analyzed using the Stata 14.0 software.ResultsA total of 9 controlled clinical studies, including 516 patients with gastric cancer, met the inclusion criteria and were included in this meta-analysis. The results of the meta-analysis showed that the 3-year OS rate was slightly higher in the IMRT group than in the 3D-CRT group, without any statistical significance. The 3-year local control rate was significantly higher in the IMRT group than in the 3D-CRT group. No significant difference in the 3-year DFS rate was found between the IMRT and 3D-CRT groups. Grade 2–4 toxicities were similar between the IMRT and 3D-CRT groups.ConclusionThe findings suggested that IMRT might be superior to 3D-CRT in treating patients with gastric cancer in terms of local control rates without increasing toxicity.
Highlights
Radiation or radiochemotherapy is a common adjuvant therapy for gastric cancer
The forest plots of the meta-analysis showed that patients with Intensitymodulated radiation therapy (IMRT) had a slightly better 3-year overall survival (OS) rate with an risk ratio (RR) of 1.16, compared with patients with Three-dimensional conformal radiation (3D-CRT) (Fig. 2) despite no statistical significance
The results of the meta-analysis indicated that IMRT was associated with a significantly better 2-year OS rate with a pooled RR of 2.49 compared with 3D-CRT
Summary
Radiation or radiochemotherapy is a common adjuvant therapy for gastric cancer. The efficacy of IMRT and 3D-CRT in gastric cancer remains controversial. This study aimed to compare the efficacy and safety of IMRT with those of 3D-CRT in treating patients with gastric cancer through conducting a meta-analysis of 3-year survival rates [overall survival (OS) and disease-free survival (DFS)], local control rates, and toxic event rates. Half of the worldwide gastric cancer cases and deaths occur in China [1, 2]. As reported by the GLOBOCAN 2012, approximately one million new gastric cancer cases and more than 700,000 cancer-related deaths occurred globally in 2012 [3]. The treatment strategy for gastric cancer is still controversial [4]. The benefits of surgical resection for patients with locally advanced gastric cancer are limited [5–8]. Perioperative strategies and adjuvant therapies, such as chemotherapy, radiotherapy, chemoradiotherapy, and targeted therapy, have been used in clinical settings for years and proved to be effective [4, 9–12]
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