High-Dose Versus Standard-Dose Intensity-Modulated Radiotherapy With Concurrent Paclitaxel Plus Carboplatin for Patients With Thoracic Esophageal Squamous Cell Carcinoma: A Randomized, Multicenter, Open-Label, Phase 3 Superiority Trial

You, Jing; Zhu, Shaihong; Li, Jiancheng; Li, Jie; Shen, Junyue; Zhao, Yidian; Li, Xiaomin; Lin, Jenshan; Liu, Qingshan; Yang, Jun; Wu, Yiqun; Shen, Wei; Wu, Haishan; Wu, Xueqin; Wang, Xiaomin; Ren, Yi; He, Jiang; Lin, Pingping; Zhu, Guangying; Shi, Anhui

doi:10.1016/j.ijrobp.2022.11.006

Cited by 16 publications

(9 citation statements)

References 24 publications

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“…Moreover, more grade 3 radiation pneumonitis occurred in the 60 Gy group compared with the 50 Gy group (33). Additionally, the study by You et al showed that the high dose of 59.4 Gy did not significantly improve the median OS of patients with LA-ESCC, with median OS of 28.1 and 26.0 months in the 59.4Gy and 50Gy groups, respectively (34). In conclusion, the results of these multicenter prospective clinical studies led to the same result: patients with locally advanced esophageal cancer receiving high radiotherapy do not achieve a more ideal OS or PFS, similar to the result of the RTOG9405 study.…”

Section: Evolution Of Dcrt For Inoperable La-esccmentioning

confidence: 96%

Current and future on definitive concurrent chemoradiotherapy for inoperable locally advanced esophageal squamous cell carcinoma

Xie,

Cai,

Chen

et al. 2024

Front. Oncol.

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Esophageal squamous cell carcinoma (ESCC) is an aggressive and fatal disease that is usually diagnosed when the chances for surgical intervention has been missed. Definitive concurrent chemoradiotherapy (dCRT) is the first choice of treatment for inoperable locally advanced esophageal squamous cell carcinoma (LA-ESCC). Nevertheless, the local recurrence rate for esophageal cancer patients undergoing dCRT remains high at 40-60%, with a 5-year overall survival rate of solely 10-30%. Immunotherapy in combination with dCRT is a promising treatment for inoperable LA-ESCC, for that improved long-term survival is expected. The present review provides a comprehensive overview of the evolutionary trajectory of dCRT for LA-ESCC, delineates notable relevant clinical studies, addresses unresolved concerns regarding the combination of dCRT with immunotherapy, and highlights promising directions for future research. When dCRT is combined with immunotherapy, the following aspects should be carefully explored in the future studies, including the optimal irradiation dose, segmentation scheme, radiotherapy technique, timing, sequence and duration of radiotherapy, and the selection of chemotherapeutic and immunologic drugs. In addition, further investigations on the mechanisms of how dCRT combined with immunotherapy exerts synergistic anti-tumor effects and molecular biomarkers ensuring precise screening of ESCC patients are needed.

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Section: Evolution Of Dcrt For Inoperable La-esccmentioning

confidence: 96%

Current and future on definitive concurrent chemoradiotherapy for inoperable locally advanced esophageal squamous cell carcinoma

Xie,

Cai,

Chen

et al. 2024

Front. Oncol.

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“…No benefit in locoregional PFS with escalated dose was shown ( 25 ). Moreover, Chinese randomized trials comparing high-dose versus standard-dose IMRT also failed to show improvement of local/regional failure-free survival and overall survival with dose-escalated CRT (59.4–60 Gy) compared with standard-dose CRT (50–50.4 Gy) for locally advanced oesphageal SCC ( 26 , 27 ).…”

Section: Definitive Chemoradiotherapymentioning

confidence: 99%

Recent progress in chemoradiotherapy for oesophageal squamous cell carcinoma

Oshima,

Tsushima,

Ito

et al. 2024

Japanese Journal of Clinical Oncology

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Oesophageal squamous cell carcinoma is a common malignancy worldwide. Definitive chemoradiotherapy is the standard treatment for patients with resectable stage oesophageal squamous cell carcinoma who cannot undergo surgery, as well as those with locally advanced unresectable oesophageal squamous cell carcinoma. However, it has several disadvantages such as poor survival, radiation-related toxicities and severe and lethal complications related to salvage treatment for residual or recurrent disease. Numerous clinical trials on chemoradiotherapy have been conducted to confirm the optimal combination of irradiation and chemotherapy. For advanced disease, multimodal treatment strategies including salvage surgery are essential. Palliative chemoradiotherapy is also crucial for dysphagia in locally advanced oesophageal squamous cell carcinoma with or without metastatic lesions. Recently, the synergistic mechanism of radiotherapy combined with immunotherapy has been reported. Early phase clinical trials suggest that a combination of immunotherapy and chemoradiotherapy can improve clinical outcomes with manageable side effects, but further investigations are needed. Here, we reviewed the existing clinical data and current development of chemoradiotherapy combined with immunotherapy in patients with oesophageal squamous cell carcinoma.

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“…We screened 6489 potential eligible articles initially with the defined search strategy. After Careful examination and discreet exclusion, seven prospective trials [18] [19] [20] [22] [23] [24] [25] were included in the meta-analysis ultimately (Table 1; exclusion reasons were shown in Figure 1), which consisted of6 randomized clinical trials and 1 non-randomized study. The sample size in each study included in the meta-analysis ranged from 28…”

Section: Eligible Studies Descriptionmentioning

confidence: 99%

“…The LPFS of the two groups were analyzed in three articles including 516 patients [18] [20] [23]. The high-dose group did not show a significant benefit when compared with the standard-dose group in this respect (HR 0.83, 95% CI 0.58 -1.17; P = 0.29; Figure 2(b)).…”

Section: Effect Of Radiation Dose On Survivalmentioning

confidence: 99%

“…In recent years, numerous studies or pooled meta-analyses showed that escalated radiation dose could improve local control (LC) and OS with no increase in serious adverse radiation-related toxicities, raising the possibility that this factor may be advantageous in dCRT [7] [8] [9] [11]- [17]. However, several recently published clinical trials [18] [19] [20] opposed that dose escalation did not result in significant benefits in survival. Hence, the question of optimal radiation dose remained unclear.…”

Section: Introductionmentioning

confidence: 99%

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Is Escalated Radiation Dose in Definitive Chemoradiotherapy Better for Inoperable Esophageal Carcinoma? A Meta-Analysis and Systematic Review

Gan¹,

Gou²,

Zhu³

et al. 2023

ABB

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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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High-Dose Versus Standard-Dose Intensity-Modulated Radiotherapy With Concurrent Paclitaxel Plus Carboplatin for Patients With Thoracic Esophageal Squamous Cell Carcinoma: A Randomized, Multicenter, Open-Label, Phase 3 Superiority Trial

Cited by 16 publications

References 24 publications

Current and future on definitive concurrent chemoradiotherapy for inoperable locally advanced esophageal squamous cell carcinoma

Current and future on definitive concurrent chemoradiotherapy for inoperable locally advanced esophageal squamous cell carcinoma

Recent progress in chemoradiotherapy for oesophageal squamous cell carcinoma

Is Escalated Radiation Dose in Definitive Chemoradiotherapy Better for Inoperable Esophageal Carcinoma? A Meta-Analysis and Systematic Review

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