Long-Term Survival in Nonsurgical Esophageal Cancer Patients Who Received Consolidation Chemotherapy Compared With Patients Who Received Concurrent Chemoradiotherapy Alone: A Systematic Review and Meta-Analysis

Abstract

BackgroundConcurrent chemoradiotherapy (CCRT) is the standard treatment for nonsurgical esophageal cancer (EC). However, esophageal cancer patients receiving CCRT alone are still unsatisfactory in terms of local control and overall survival (OS) benefit. Clinicians generally add consolidation chemotherapy (CCT) after CCRT. It remains controversial whether CCT following CCRT is beneficial for esophageal cancer. We, therefore, undertook a meta-analysis to assess the need for CCT in inoperable esophageal cancer.Materials and MethodsWe combed PubMed, Embase, Cochrane Library, Web of Science, and CNKI for relevant published articles up to July 2020 that compared CCRT plus CCT to CCRT alone for patients with nonsurgical EC. Our primary endpoint was OS and progression-free survival (PFS), and the secondary endpoint was treatment toxicity. We analyzed the hazard ratio (HR) to estimate the time-to-event data and the odds ratio (OR) to compare the treatment-related effect. To assess heterogeneity, we performed the I2 test and examined publication bias using funnel plots analysis.ResultsThe 11 retrospective studies involved 2008 patients. Of these 2008 patients, 1018 received CCRT plus CCT, and 990 received CCRT. Compared to CCRT alone, CCT after CCRT did not improve disease control rate (DCR) (OR 1.66; 95% CI 0.53–5.15, p=0.384) and objective response rate (ORR) (OR 1.44; 95% CI 0.62–3.35, p=0.393). However, OS (HR 0.72; 95% CI 0.59–0.86, p < 0.001) and PFS (HR 0.61; 95% CI 0.44–0.84, p=0.003) did increase. Our results show that CCT plus CCRT had a clear survival advantage over CCRT alone. The risk of treatment toxicity did not increase for EC patients who received CCT.ConclusionCCT after CCRT significantly increases OS and PFS in patients with nonsurgical EC and could provide them remarkable survival benefits. The results provide an evidence-based framework for the use of CCT after CCRT.

Consolidative chemotherapy after definitive concurrent chemoradiotherapy for esophageal squamous cell carcinoma patients: a population based cohort study

“…In our mind, our results were compatible with the results in the above-mentioned systematic review in that the point estimate of HR for OS was in favor of CCT [ 11 ]. In another systematic review published in 2021 (not limited to SqCC but consisted of mainly SqCC patients) [ 37 ], favorable OS (HR 0.72; 95% CI 0.59–0.86, P < 0.001) and response rate (OR 1.44; 95% CI 0.62–3.35, P = 0.393) were reported. Our results were relatively close to these results.…”

Efficacy and Prognostic Analysis of 315 Stage I–IVa Esophageal Cancer Patients Treated with Simultaneous Integrated Boost-Intensity-Modulated Radiation Therapy

“…Adjuvant chemotherapy is considered to eliminate circulating tumor cells in the blood to prevent distant metastasis of the tumor. 25 However, recurrence of esophageal cancer typically occur in situ, and chemotherapy therefore needs to reach the tumor tissue through blood circulation. As the esophageal blood supply after RT is reduced, the survival benefit is diminished.…”

Short-term response might influence the treatment-related benefit of adjuvant chemotherapy after concurrent chemoradiotherapy for esophageal squamous cell carcinoma patients

“…Although the RTOG 85-01 and PRODIGE-5 trials both took AC into account during their treatment design, the current guidelines do not recommend AC as a standard treatment [ 9 , 10 ]. The role of AC after CCRT has not been explored in randomized controlled clinical trials, and the retrospective studies have yielded mixed results [ 11 ]. Some researchers found that AC could not increase survival benefits, while others showed that AC could improve survival [ 12 , 13 ].…”