The impact of radiation dose on the efficacy of definitive chemoradiotherapy in patients with locally advanced esophageal carcinoma: a systematic review and meta-analysis

Abstract

To investigate the impact of radiation dose on the efficacy of definitive chemoradiotherapy(dCCRT) in patients with locally advanced esophageal carcinoma. PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Wanfang, and Chinese National Knowledge Infrastructure(CNKI) were searched for eligible studies. Studies that compared high-dose radiation(HD-RT) group with low-dose radiation(LD-RT) group using modern radiotherapy techniques for locally advanced esophageal carcinoma patients in dCCRT were identified. The hazard ratios (HR) for overall survival (OS), progression-free survival (PFS), and the odds ratios (OR) for clinical complete response (cCR), local–regional failure (LRF), distant metastasis (DM), and grade≥3 AEs. Meta-analysis was performed when relevant data were available. Eleven studies involving 1943 patients were included for analyses. The results showed that the HD-RT group had better OS (pooled HR 0.78 [0.70, 0.87], p < .00001), PFS (pooled HR 0.72 [0.55, 0.94], p = .01), cCR (OR 1.52 [1.13, 2.05], p = .005), and LRF (OR 0.60 [0.45, 0.80], p = .0004). In addition, there were no significant differences between the two groups in terms of DM (OR 1.43 [1.00, 2.04], p = .05), grade 3–5 radiation pneumonitis (OR 1.38 [0.71, 2.68], p = .35), grade 3–5 radiation esophagitis (OR 1.36 [0.88, 2.10], p = .17), grade 3–5 other esophageal toxicities(stenosis/fistula/hemorrhage) (OR 1.22 [0.75, 2.00], p = .43), and treatment-related death (OR 1.40 [0.73, 2.68], p = .31). High-dose radiotherapy in definitive CCRT for patients with locally advanced esophageal carcinoma is associated with improved PFS, OS, cCR, and LC with no increase of grade≥3AEs. Simultaneously, we await the preliminary and final results of several ongoing dose-escalation randomized trials. Furthermore, future studies should provide personalized radiotherapy doses for these patients.

Patients with Spondylodiscitis following Chemoradiotherapy for Head and Neck Cancer in a Portuguese Cancer Hospital: A Case Report

“…Treatment options for head and neck cancer include surgery, radiation therapy, and chemotherapy, with specific treatment plans depending upon individual tumor location and tumor stage, together with overall patient health status [ 1 ]. Furthermore, definitive chemoradiotherapy (dCRT) has emerged as a standard-of-care treatment for locoregional advanced head and neck squamous cell cancer [ 2 ]. In summary, dCRT consists of a complex combination of chemotherapy and radiation, that is highly successful in treating non-metastatic head and neck squamous cell cancer, whenever the condition is unresectable and requires organ preservation or when patients refuse surgery [ 3 ].…”

Pericardial irradiation dose may be strongly associated with grade 4 lymphopenia and affect prognosis in patients with locally advanced esophageal cancer receiving definitive concurrent chemoradiotherapy

“…Radical concurrent chemoradiotherapy (CCRT) is the standard of care for patients with unresectable locally advanced esophageal cancer (LA‐EC). However, survival remains disappointing, with a 5‐year overall survival (OS) of only about 20% 1 . The RTOG 0617 phase 3 clinical trial suggests that higher radiation doses may lead to poorer OS in patients with non‐small cell lung cancer (NSCLC) 2 .…”

“…However, survival remains disappointing, with a 5‐year overall survival (OS) of only about 20%. 1 The RTOG 0617 phase 3 clinical trial suggests that higher radiation doses may lead to poorer OS in patients with non‐small cell lung cancer (NSCLC). 2 This may be because the delivery of high‐dose radiotherapy increases the risk of radiation‐induced injury to organs at risk (OARs), such as the heart, pericardium, and lungs.…”