TITLE:
Is Escalated Radiation Dose in Definitive Chemoradiotherapy Better for Inoperable Esophageal Carcinoma? A Meta-Analysis and Systematic Review
AUTHORS:
Xiaochuan Gan, Qitao Gou, Jing Zhu, Tao Zhang
KEYWORDS:
Esophageal Carcinoma, Chemoradiotherapy, High-Dose, Low-Dose, Meta-Analysis
JOURNAL NAME:
Advances in Bioscience and Biotechnology,
Vol.14 No.4,
April
28,
2023
ABSTRACT: 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.