The Optimal Radiation Dose Of Concurrent Chemoradiotherapy For Esophageal Carcinoma With Modern Radiotherapy Techniques: A Meta-Analysis

Abstract

The aim of this meta-analysis was to evaluate the clinical benefit of different radiation doses in concurrent chemoradiotherapy for esophageal carcinoma with modern radiotherapy techniques. We systematically searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Wanfang and Chinese National Knowledge Infrastructure (CNKI) databases. Studies which compared low dose group with high dose group for esophageal cancer patients after surgery were eligible. Outcomes of interest were odds ratios (OR) for overall survival (OS), local-regional recurrence, distant metastasis and adverse-event rate. R 3.6.2 software was utilized for statistical analysis. 12 studies involving 10896 patients were finally included. The results of the meta-analysis showed that high dose group had higher 3-year and 5-year overall survival (OR = 0.77, 95%CI: 95%CI = 0.61–0.98, P = 0.04; OR = 0.67, 95% CI = 0.48–0.93, P = 0.02) and the local-regional control (OR = 0.59, 95% CI = 0.46–0.76), especially for patients who received ≥ 60 Gy radiation. The subgroup analyses showed that ≥ circa 60Gy can significantly improve the 1-year 3-year and 5-year overall survival (OR = 0.68, 95%CI = 0.59–0.78, P<0.0001; OR = 0.63, 95% CI = 0.54–0.74, P<0.0001; OR = 0.55, 95% CI = 0.46–0.66, P<0.0001) as well as the local-regional control (OR = 1.21, 95% CI = 0.92–1.59, P = 0.17) as compared with < circa 60Gy. The subgroup analysis compared ≤ 50.4Gy with > 50.4Gy showed no significant benefits for 3-year and 5-year overall survival (OR = 1.06, 95% CI = 0.96–1.18, P = 0.25; OR = 1.06, 95% CI = 0.94–1.18, P = 0.35) and local-regional control (OR = 0.71, 95% CI = 0.46–1.09, P = 0.18). There is no significant differences between the two groups in grade 3-5 radiation pneumonitis (OR = 1.05, 95% CI = 0.54–2.05, P = 0.89), grade 3-5 radiation esophagitis (OR = 1.40, 95% CI = 0.93–2.11, P = 0.11) and distant metastasis ( OR = 1.79, 95%CI: 0.72∼4.50, P = 0.21). Compared with low dose radiotherapy, high dose radiotherapy (especially for ≥ 60Gy) had more favorable survival outcomes and tolerant toxicities in the concurrent chemoradiotherapy of esophageal carcinoma with modern radiation techniques. High radiation dose is recommended for definitive concurrent chemoradiation in esophageal carcinoma.