Outcomes of Localized Esophageal Squamous Cell Carcinoma Patients Treated With Definitive Concurrent Chemoradiotherapy Using Either Standard or High Radiotherapy Dose: A Retrospective Study Controlling for Organ at Risk Dose

Li, Chia‐Chin; Fang, Hsin‐Yuan; Lin, Chun-Cheng; Chien, Chun-Ru

doi:10.21873/anticanres.13142

Cited by 9 publications

(14 citation statements)

References 29 publications

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“…The characteristics of 12 studies were presented in Table 1 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), which consisted of 1 RCT (11), four population-based propensity-score matched analyses (14,15,20,22), and seven retrospective control studies (12,13,(16)(17)(18)(19)21). There were nine studies that came from Asian countries (including one from Korea, four from Taiwan area, and three from China) and three studies from western countries (including two from USA and one from France).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…64.7 and 33.4% of patients were diagnosed with squamous cell carcinoma (SCC) and adenocarcinoma (AC), respectively. Nine studies enrolled patients with SCC only (11,13,(15)(16)(17)(19)(20)(21)(22), while for the other three studies both SCC and AC were eligible. Tumor nodal metastasis (TNM) stage of the patients ranged from I to IV.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…We categorized the 12 studies into subgroups based on the threshold of <circa 60 Gy vs. ≥circa 60 Gy (due to the difference in the fraction dose radiotherapy, the thresholds of 59.4 and 60 Gy were included in the circa 60-Gy subgroup) and ≤50.4 vs. >50.4 Gy. Seven studies were included in the subgroup analysis of <circa 60 Gy (range: 45-59.4 Gy) vs. ≥circa 60 Gy (range: 60-72 Gy)(15)(16)(17)(18)(20)(21)(22). Four studies were included in the subgroup analysis of ≤50.4 Gy (range: 38-50.4 Gy) vs. > 50.4 Gy (range: 38-50.4 Gy)(12)(13)(14)19)…”

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confidence: 99%

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High vs. Low Radiation Dose of Concurrent Chemoradiotherapy for Esophageal Carcinoma With Modern Radiotherapy Techniques: A Meta-Analysis

Sun

Wang

et al. 2020

Front. Oncol.

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The aim of this study was to evaluate the clinical benefit of different radiation doses in concurrent chemoradiotherapy (CCRT) for esophageal carcinoma using modern radiotherapy techniques. Methods: A systematic review was conducted by screening PubMed, EMBASE, Cochrane Central Register of Controlled Trials, SCOPUS, Wanfang, and Chinese National Knowledge Infrastructure (CNKI) databases with prespecified searching strategy. Studies which compared high radiation dose group with low-dose radiation group using modern radiotherapy techniques for esophageal cancer patients in CCRT were identified. The hazard ratios (HR) for overall survival (OS) and the odds ratios (OR) for local-regional failure (LRF), distant metastasis (DM), and toxicities were considered as the outcomes of interest. R 3.6.2 software was used for statistical analysis. Conclusions: For esophageal carcinoma receiving CCRT with modern radiation techniques, evidence suggested that high-dose radiotherapy, especially ≥circa 60 Gy, had potentials to improve the OS and local-regional control without increase in severe toxicities when compared with low-dose radiotherapy. The result needs to be confirmed by randomized clinical trials.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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confidence: 99%

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High vs. Low Radiation Dose of Concurrent Chemoradiotherapy for Esophageal Carcinoma With Modern Radiotherapy Techniques: A Meta-Analysis

Sun

Wang

et al. 2020

Front. Oncol.

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“…We included the following covariates as modified from recent relevant studies and our clinical and research experiences. [7][8][9][10]18 Patient demographics (age, gender, residency), patient characteristics (body mass index [BMI], drinking, smoking), disease characteristics (T and N and overall stage), treatment characteristics (peri-CCRT systemic F I G U R E 1 STROBE study flowchart and the number of individuals at each stage of the study. 1.…”

Section: Covariatesmentioning

confidence: 99%

Optimal radiotherapy dose in cervical esophageal squamous cell carcinoma patients treated with definitive concurrent chemoradiotherapy: A population based study

Li¹,

Chen

Chou

et al. 2021

Thoracic Cancer

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Background: The optimal radiotherapy dose for locally advanced cervical esophageal squamous cell carcinoma (C-ESqCC) treated with definitive concurrent chemoradiotherapy (dCCRT) is unclear. Here, we aimed to compare the survival of those treated with high dose versus standard dose via a population based approach. Methods: Eligible C-ESqCC patients diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance observable potential confounders between groups. The hazard ratio (HR) of death and incidence of esophageal cancer mortality (IECM) were compared between high (60-70 Gy) and standard dose (50-50.4 Gy). We also evaluated the outcome in supplementary analyses via alternative approaches. Results: Our primary analysis consisted of 141 patients in whom covariates were well balanced after PS weighting. The HR of death when high dose was compared with standard dose was 0.65 (95% confidence interval [CI]: 0.4-1.03, p = 0.07). The HR of IECM was 0.74 (p = 0.45). The HR of OS remained similarly insignificant in supplementary analyses. Conclusions: We observed a trend in favor of high radiotherapy dose versus standard dose for C-ESqCC treated with dCCRT in this population-based nonrandomized study. Further studies are needed to confirm the findings of the study.

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“…Given the above, radiation dose escalation has been proposed as a technique to obtain higher local-regional control (LRC) and survival rates, notably in Asian countries [14][15][16][17][18][19][20][21][22][23][24] . In recent years, multiple investigators have carried out studies comparing the curative impact of high-dose versus standard-dose radiation treatments, although conclusions have been inconsistent [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] . Additionally, with advances in radiotherapy techniques, questions have been raised as to whether dose escalation utilizing computerized tomography (CT)-based radiotherapy approaches (including 3-Dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and proton therapy) could achieve improved outcomes with less toxicity compared to older approaches from the 2-D era.…”

Section: Ivyspringmentioning

confidence: 99%

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

Xiao¹,

Czito²,

Pang³

et al. 2020

J. Cancer

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Background: To investigate the effects and safety profile of radiation dose escalation utilizing computerized tomography (CT) based radiotherapy techniques (including 3-Dimensional conformal radiotherapy, intensity-modulated radiotherapy and proton therapy) in the definitive treatment of patients with esophageal carcinoma (EC) with definitive concurrent chemoradiotherapy (dCCRT). Methods: All relevant studies utilizing CT-based radiation planning, comparing high-dose (≥ 60 Gy) versus standard-dose (50.4 Gy) radiation for patients with EC were analyzed for this meta-analysis. Results: Eleven studies including 4946 patients met the inclusion criteria, with 96.5% of patients diagnosed with esophageal squamous cell carcinoma (ESCC). 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 local-regional control (LRC) (OR 0.478, 95% CI 0.309-0.740; P=0.001), two-year overall survival (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. Conclusion: Under the premise of controlling the rate of toxicities, doses of ≥ 60 Gy in CT-based dCCRT of ESCC patients might improve locoregional control and ultimate survival compared to the standard-dose dCCRT. While our review supports a dose-escalation approach in these patients, multiple ongoing randomized trial initial and final reports are awaited to evaluate the effectiveness of this strategy.

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Outcomes of Localized Esophageal Squamous Cell Carcinoma Patients Treated With Definitive Concurrent Chemoradiotherapy Using Either Standard or High Radiotherapy Dose: A Retrospective Study Controlling for Organ at Risk Dose

Cited by 9 publications

References 29 publications

High vs. Low Radiation Dose of Concurrent Chemoradiotherapy for Esophageal Carcinoma With Modern Radiotherapy Techniques: A Meta-Analysis

High vs. Low Radiation Dose of Concurrent Chemoradiotherapy for Esophageal Carcinoma With Modern Radiotherapy Techniques: A Meta-Analysis

Optimal radiotherapy dose in cervical esophageal squamous cell carcinoma patients treated with definitive concurrent chemoradiotherapy: A population based study

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

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