Do Higher Radiation Doses with Concurrent Chemotherapy in the Definitive Treatment of Esophageal Cancer Improve Outcomes? A Meta-Analysis and Systematic Review

Xiao, Linlin; Czito, Brian G.; Pang, Qingsong; Hui, Zhouguang; Jing, Shaowu; Shan, Baoen; Wang, Jun

doi:10.7150/jca.44447

Cited by 14 publications

(6 citation statements)

References 39 publications

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“…In NCCN EC guidelines [14] recommend the radiation dose of 50 or 50.4 Gy for definitive chemo-radiotherapy, radiation dose escalation in the treatment of EC should be studied further. In the recent meta-analysis of trials [24] comparing high-dose (≥ 60 Gy) versus standard-dose (50.4 Gy) radiation for patients with EC, the high-dose group demonstrated a significant improvement in Local-Regional Failure (LRF) (OR 2.199, 95% CI 1.487-3.253; P<0.001), two-year localregional control (LRC) (OR 0.478, 95% CI 0.309-0.740; P=0.001), two-year OS (HR 0.744, 95% CI 0.657-0.843; P<0.001) and five-year OS (HR 0.683, 95% CI 0.561-0.831; P<0.001) rates relative to the standard-dose group. In addition, there was no difference in grade ≥ 3 radiation-related toxicities and treatment-related deaths between the groups.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome of High Dose Radiotherapy With or Without Concurrent Chemotherapy in Esophageal Cancer (Ec): A Study From North – East India

Talukdar¹

2023

Journal of Pharmaceutical Negative Results

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OBJECTIVE: The objective of this study is to evaluate the clinical outcomes of high dose radiotherapy 63 Gray (Gy) with or without concurrent chemotherapy in Esophageal Cancer (EC) patients of North-East, India. MATERIAL AND METHODS: All reported EC patients belonging to different states of North-East and treated with radical intent with high dose radiotherapy with or without concurrent chemotherapy during the period 2017-2018 (2 years) at State Cancer Institute (SCI),Gauhati Medical College (GMC), Assam, India were included in the study. This study was retrospective in nature and two years retrospective data were analyzed for clinical outcome. Statistical analysis of data was done using Statistical Packages for Social Sciences (SPSS) and Disease Free Survival (DFS) was calculated using Kaplan-Meier method. RESULTS: Total 105 patients were treated during the period. All patients received a total dose of 63 Gy radiation. Out of 105 patients, 76 patients (72.4%) received concurrent chemotherapy and 29 patients (27.6%) not received chemotherapy only due to co-morbidities. Here, at first follow up, 89 (84.8%) patients showed complete response, 10 (9.5%) showed partial response and 6 (5.7%) showed progressive disease. Treatment related toxicities were assessed. None of the patient developed > Grade 2 toxicity. Further, Median Disease Free Survival (DFS) was 13 months with estimated mean was 16.98 months. Also, Standard Error (SE) =1.683, Confidence Interval (CI) =13.682-20.279. CONCLUSION: The high dose radiation (63 Gy) with concurrent chemotherapy as weekly regimen of Cisplatin or Paclitaxel plus Carboplatin is an effective definitive treatment of Stage I – IVA EC with acceptable toxicity. Median DFS is minimal in EC irrespective of the treatment. The rate of survival is decreasing rapidly before the median DFS and the rate of survival is constant after the Median DFS.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcome of High Dose Radiotherapy With or Without Concurrent Chemotherapy in Esophageal Cancer (Ec): A Study From North – East India

Talukdar¹

2023

Journal of Pharmaceutical Negative Results

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“…The reason likely was that the radiation dose of the present study was different from the PRODIGE5/ACCORD17 trial. A larger meta-analysis ( 23 ) reported that CCRT with doses of ≥60 Gy for ESCC patients might improve locoregional control and survival compared with the standard-dose CCRT. More than half of the patients received the prescribed total dose of ≥60 Gy, whereas the PRODIGE5/ACCORD17 trial used the standard dose radiation (50 Gy) with a conventional fraction.…”

Section: Discussionmentioning

confidence: 99%

Induction Chemotherapy Followed by Chemoradiotherapy With or Without Consolidation Chemotherapy Versus Chemoradiotherapy Followed by Consolidation Chemotherapy for Esophageal Squamous Cell Carcinoma

et al. 2022

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ObjectiveThis study aimed to compare the efficacy and safety of induction chemotherapy followed by concurrent chemoradiotherapy (I-CCRT), induction chemotherapy followed by concurrent chemoradiotherapy and consolidation chemotherapy (I-CCRT-C), and concurrent chemoradiotherapy followed by consolidation chemotherapy (CCRT-C) for locally advanced esophageal squamous cell carcinoma (ESSC).Patients and MethodsPatients with locally advanced ESCC who underwent definitive chemoradiotherapy with cisplatin plus fluorouracil or docetaxel from February 2012 to December 2018 were retrospectively reviewed. Kaplan–Meier curve was used to estimate survival. Efficacy was assessed using RECIST, version 1.0. Prognosis factors were identified with Cox regression analysis.ResultsPatients were treated with CCRT-C (n = 59), I-CCRT (n = 20), and I-CCRT-C (n = 48). The median follow-up duration was 73.9 months for the entire cohort. The ORR of the CCRT-C, I-CCRT, and I-CCRT-C groups was 89.8%, 70.0%, and 77.1%, respectively (p = 0.078). The median PFS in the CCRT-C, I-CCRT, and I-CCRT-C groups was 32.5, 16.1, and 27.1 months, respectively (p = 0.464). The median OS of the CCRT-C, I-CCRT, and I-CCRT-C groups was 45.9, 35.5, and 54.0 months, respectively (p = 0.788). Cox regression analysis indicated that I-CCRT-C and I-CCRT did not significantly prolong PFS and OS compared with CCRT-C (p > 0.05). Neutropenia grade ≥3 in CCRT-C, I-CCRT, and I-CCRT-C groups was 47.5%, 15%, and 33.3% of patients, respectively (p = 0.027).ConclusionsI-CCRT and I-CCRT-C using cisplatin plus fluorouracil or docetaxel regimen are not superior to CCRT-C in survival but seem to have less severe neutropenia than CCRT-C. Further randomized controlled studies are warranted.

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“…To date, few studies have reported the rate of local control following re-irradiation therapy in patients with LRESCC. Although previous studies have reported that higher radiation doses can improve the local control rate of esophageal cancer and survival rate [ 21 , 22 ]. In the present study, the 3-year locoregional control rate in the LD group and HD group was 3.4% and 14.9%, respectively.…”

Section: Discussionmentioning

confidence: 99%

A re-irradiation dose of 55–60 Gy improves the survival rate of patients with local recurrent esophageal squamous cell carcinoma after radiotherapy

Chen

et al. 2021

Radiat Oncol

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Introduction Local recurrence (LR) is clinical challenge in the treatment of esophageal squamous cell carcinoma (ESCC). The current study aimed to determine the optimal re-irradiation dose for local recurrent esophageal squamous cell carcinoma (LRESCC) following radical (chemo) radiotherapy. Methods We retrospectively analyzed 125 patients with LRESCC after receiving initial radiotherapy. For radiotherapy treatment, 58 patients were assigned to low-dose (LD) group (50–54 Gy) and 67 were assigned to the high-dose (HD) group (55–60 Gy). The response rate (complete + partial response), 1-, 2- and 3-year survival rate, and toxicity were recorded. We then analyzed the impact of different radiotherapy doses and combination chemotherapy on the survival of patients with LRESCC. Results After re-irradiation, the 1-, 2- and 3-year survival rates in the LD and HD groups were 48.3%, 24.1% and 10.3% and 61.2%, 34.3% and 19.4% in the HD group, respectively, and the difference in overall survival rate between the two groups were significant (P < 0.05). The median survival time of patients receiving radiotherapy alone was 9 months in the LD group and 15 months in the HD group (P < 0.05). The survival rate of patients treated with chemoradiotherapy was higher than that of patients treated with radiotherapy alone in the LD group. However, chemoradiotherapy showed no advantage over radiotherapy alone in the HD group. In addition, the incidence of radiation esophagitis, the most common toxicity, was higher in the HD group compared to the LD group (68.7% vs 58.6%). Multivariate analysis demonstrated that re-irradiation dose was an independent favorable prognostic factor in patients with LRESCC. Conclusion Higher re-irradiation dose (55–60 Gy) can improve the long-term survival of patients with LRESCC after radiotherapy, with tolerable toxicity.

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Do Higher Radiation Doses with Concurrent Chemotherapy in the Definitive Treatment of Esophageal Cancer Improve Outcomes? A Meta-Analysis and Systematic Review

Cited by 14 publications

References 39 publications

Clinical Outcome of High Dose Radiotherapy With or Without Concurrent Chemotherapy in Esophageal Cancer (Ec): A Study From North – East India

Clinical Outcome of High Dose Radiotherapy With or Without Concurrent Chemotherapy in Esophageal Cancer (Ec): A Study From North – East India

Induction Chemotherapy Followed by Chemoradiotherapy With or Without Consolidation Chemotherapy Versus Chemoradiotherapy Followed by Consolidation Chemotherapy for Esophageal Squamous Cell Carcinoma

A re-irradiation dose of 55–60 Gy improves the survival rate of patients with local recurrent esophageal squamous cell carcinoma after radiotherapy

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