A Meta-Analysis of Concurrent Chemoradiotherapy for Advanced Esophageal Cancer

Abstract

BackgroundConcurrent chemoradiotherapy is a standard treatment for local advanced esophageal cancer, but the outcomes are controversial. Our goals were to compare the therapeutic effects of concurrent chemoradiotherapy and radiotherapy alone in local advanced esophageal cancer using meta-analysis.MethodsMEDLINE, EMBASE and the Cochrane library were searched for studies comparing chemoradiotherapy with radiotherapy alone for advanced esophageal cancer. Only randomized controlled trials were included, and extracted data were analyzed with Review Manager Version 5.2. The pooled relative risks (RR) and their 95% confidence intervals (CI) were calculated for statistical analysis.ResultsNine studies were included. Of 1,135 cases, 612 received concurrent chemoradiotherapy and 523 were treated with radiotherapy alone. The overall response rate (complete remission and partial remission) was 93.4% for concurrent chemoradiotherapy and 83.7% for radiotherapy alone (P = 0.05). The RR values of 1-year, 3-year, and 5-year survival rates were 1.14 (95% CI: 1.04 - 1.24, P = 0.006), 1.66 (95% CI: 1.34 - 2.06, P < 0.001), and 2.43 (95% CI: 1.63 - 3.63, P < 0.001), respectively. The RR value of the merged occurrence rate of acute toxic effects was 2.34 (95% CI: 1.90 - 2.90, P <0.001). There was no difference in the incidence of late toxic effects, which had an RR value of 1.21 (95% CI: 0.96 - 1.54, P = 0.11). The RR level of persistence and recurrence was 0.71 (95% CI: 0.62 - 0.81, P <0.001), and for the distant metastasis rate, the RR value was 0.79 (95% CI: 0.61 - 1.02, P = 0.07).ConclusionsConcurrent chemoradiotherapy significantly improved overall survival rate, reduced the risk of persistence and recurrence, but had little effect on the primary tumor response, and increased the occurrence of acute toxic effects.

Olanzapine versus fosaprepitant for the prevention of concurrent chemotherapy radiotherapy-induced nausea and vomiting

“…[14][15][16] Concurrent chemotherapy radiotherapy is commonly used for locally advanced head and neck cancers 17 and locally advanced esophageal cancers. 18 Tere are no known prospective phase 3 clinical trials for the prevention of chemotherapy radiotherapy-induced nausea and vomiting for these malignancies. Published guidelines 15 suggest that antiemetic prophylaxis for chemotherapy radiotherapy treatment should be based on the emetogenicity of the chemotherapy.…”

Efficacy of chemo-radiotherapy versus radiotherapy alone in the treatment of esophageal carcinoma

“…A recent meta-analysis that included nine studies, demonstrated that concurrent use of chemoradiotherapy significantly improved OS, reduced the risk of persistence and recurrence, but increased the occurrence of acute toxic effects, compared with radiotherapy alone [14]. A previous study from India that included 125 patients with unresectable SCC of the esophagus, showed 57.6%, 38.9% and 24.8% versus 32.3%, 22.8% and 13.7% OS at 1, 2, and 5 year, for chemo-radiotherapy and radiotherapy alone groups, respectively [24].…”

“…In a meta-analysis by Zhu et al, nine studies which included 1,135 cases (612 received concurrent chemoradiotherapy and 523 received radiotherapy alone) showed that patients who received concurrent chemoradiotherapy, demonstrated significantly higher overall response rate and reduced the risk of persistence and recurrence of disease [14][15][16][17][18].…”

Nanoparticles for radiooncology: Mission, vision, challenges

“…suppression of bone marrow, as well as nonhematologic adverse effects. This range from dysfunction of liver and kidneys, loss of hair, diarrhea, nausea to reversible but also irreversible skin reactions to lymphedema, tissue fibrosis and even induction of secondary cancers (see for example: [346][347][348][349][350][351]). One of the future therapeutic challenges is thus the development of directed therapy approaches, addressing the tumor more specifically, while sparing the remaining tissues, and increasing the efficiency of the conventional chemotherapeutics or further active ingredients.…”