Is Escalated Radiation Dose in Definitive Chemoradiotherapy Better for Inoperable Esophageal Carcinoma? A Meta-Analysis and Systematic Review — Oak Academic Publishing
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Is Escalated Radiation Dose in Definitive Chemoradiotherapy Better for Inoperable Esophageal Carcinoma? A Meta-Analysis and Systematic Review
Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
1 Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
2 Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
3 Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
4 Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Purpose: This study aimed to compare the survival benefits between different total radiation doses in definitive chemoradiotherapy (dCRT) for inoperable esophageal carcinoma (EC) based on modern radiotherapy techniques. Methods: A systematic review was performed by searching the databases of PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science. All studies published prior to November 30, 2022 , comparing radiation dose and disease-related outcomes in EC patients. The hazard ratio (HR) and odds ratio (OR) were used to describe the risk of outcomes and toxicities. Results: Seven prospective trials involving 1124EC patients were enrolled for analyses. The results revealed that the effect on overall survival (HR = 0.99, 95% CI = 0.85 - 1.16, P = 0.94), local progression-free survival (HR = 0.83, 95% CI = 0.58 - 1.17, P = 0.29), local regional progression-free survival (HR = 0.94, 95% CI = 0.76 - 1.17, P = 0.61), progression-free survival (HR = 0.90, 95% CI = 0.71 - 1.13, P = 0.35) was similar in the high-dose and standard-dose groups. Additionally, a high radiation dose exhibited a potential disadvantage in respiratory toxicities when compared with a standard dose (4.8% vs 2.2%, OR 2.11, P = 0.06). Conclusions: The efficacy of the HD group ( ≥60 Gy) and the SD group (approximately 50 Gy) for inoperable local advanced EC was similar. However, the HD group exhibited a high radiation dose exhibited a potential disadvantage in respiratory toxicities when compared with a standard dose. Simultaneously, the final results of several ongoing prospective trials regarding the optimal radiation dose in dCRT are awaited.
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