Comparasion of elective nodal irradiation and involved-field irradiation in esophageal squamous cell carcinoma: a meta analysis

Abstract

It is still controversial whether radical radiotherapy in patients with esophageal squamous cell carcinoma (ESCC) still requires elective nodal irradiation (ENI), or only involved-field irradiation (IFI). In this study, a meta analysis was used to compare ENI and IFI in the treatment of ESCC, in order to provide guidance for clinical practice. Methods: Literatures on ENI and IFI in treatment of ESCC were retrieved, and the last access was June 30, 2017. A meta analysis was performed to evaluate the advantage and disadvantage of ENI and IFI. Results: Nine studies with a total of 1143 patients were included in this analysis, of those 605 patients underwent radiotherapy only, and 538 underwent radiochemotherapy. There was no significant difference in 1-, 2-, 3-year local control rate between ENI and IFI, or 1-, 2-, 3-year overall survival rates. However, the incidences of ≥ 3 grade acute esophagitis and pneumonia were significantly lower in IFI group. There was no difference in the rate of out-field recurrence/metastasis in this two groups. Conclusions: Neither local control rates nor overall survival rates between ENI and IFI groups have significant differences, but in the latter group, incidences of severe radiation esophagitis and pneumonia are significantly lower. IFI is not associated with increasement of out-field recurrence/ metastasis. It is noteworthy that most of the included studies are retrospective. Therefore, a large prospective randomized study is needed for further investigation and verification.

The role of involved field irradiation versus elective nodal irradiation in definitive radiotherapy or chemoradiotherapy for esophageal cancer- a systematic review and meta-analysis

“…Therefore, more prospective studies are needed to validate this finding. In our study, IFI showed significant reductions in the incidence of grade ≥3 AE compared with ENI, which is similar to that reported in most studies ( 45 , 49 , 50 ). Compared with the 3D-CRT and 3D-IMRT–mixed subgroups, there were no differences in the incidence of grade ≥3 AE in the IMRT subgroup, which could be explained by the fact that IMRT may reduce the difference in the incidence rates of grade ≥3 AE between two groups.…”

“…( 49 ) and Jing et al. ( 50 ). The databases these two authors searched included the China National Knowledge Infrastructure (CNKI) and Chinese Biomedical Literature Database, without including the Web of Science database, which differed from the databases included in the present study.…”

“…Moreover, studies by Jing et al. ( 50 ) and Cheng et al. ( 49 ) were performed before 2015 except for one study by Cheng et al.…”

Intensity modulated radiation therapy for elderly patients with esophageal cancer: our experience

“…Fewer Studies reported that three field lymph node dissection in surgical treatment was effective in reducing the incidence of micrometastasis, and the survival rate and local control rate were significantly increased. Therefore, it is of great significance to appropriately increase the radiation range of radiotherapy to reduce the recurrence rate of lymph nodes [21]. Several prospective and retrospective studies reported that the efficacy of IFI was basically similar to ENI, but adverse events were significantly less than ENI, Compared with ENI, IFI have showed similar efficacy and reduced radiation-induced toxicity [22,23].…”