High-dose versus conventional-dose irradiation in cisplatin-based definitive concurrent chemoradiotherapy for esophageal cancer: a systematic review and pooled analysis

Abstract

We investigate whether high-dose (HD, ≥60 Gy) radiotherapy in definitive concurrent chemoradiotherapy (CCRT) based on cisplatin could yield benefits compared to conventional-dose (CD) CCRT. PubMed, Embase and Google Scholar were searched and data were pooled and analyzed for response rate, survival, failure patterns and toxicity. Results showed advantages in response rate, 5-year overall survival rate, local regional recurrence and distant failure rate compared to the CD arm with no difference in Grade ≥3 acute and late esophagitis, other toxicities were rare with moderate tolerance, subgroup analysis of squamous cell carcinoma also showed advantages for HD arm. We concluded that ≥60 Gy CCRT improved clinical outcomes compared to the CD arm, especially for esophageal squamous cell carcinoma. Our findings may provide a basis for future trials.

Keywords:

• chemotherapy
• concurrent chemoradiotherapy
• conventional-dose
• esophageal cancer
• esophageal squamous cell carcinoma
• high-dose
• radiation dose
• radiotherapy

Financial & competing interests disclosure

The authors indicated no potential conflicts of interest. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Definitive concurrent chemoradiotherapy is feasible for esophageal cancer with acceptable toxicities in both high-dose arm and conventional-dose arm.

• The response rates (complete remission and overall response rate) were significantly higher in the high-dose arm.

• A long-term survival benefit might exist in the high-dose concurrent chemoradiotherapy arm.

• Subgroup analysis for only squamous cell carcinoma showed clinical advantages for high-dose radiotherapy arm than conventional-dose arm with no increases of radiation-related toxicities.

• Prospective randomized trials are urgently needed.

Notes