Can involved-field irradiation replace elective nodal irradiation in chemoradiotherapy for esophageal cancer? A systematic review and meta-analysis

Figures & data

Figure 1 Selection criteria of the included studies.

Abbreviations: IFRT, involved-field radiotherapy; ENI, elective nodal irradiation; ASTRO, American Society for Radiation Oncology.

Table 1 Basic characteristics of the included studies

Author (year)	Enrollment year	Patient number	Pathology	Location	Treatment	Radiation dose (Gy)	Radiation technique	IFI patient number	ENI patient number
Ma et al^Citation12 (2011)	September 2004 to April 2006	102	SCC	Cervical (n=33) and upper thoracic esophageal (n=69)	CCRT + CT	41.4 Gy/23 F (1.8 Gy, qd) +18 Gy/12 F (1.5 Gy, bid) DT: 59.4 Gy	3D-CRT	51	51
Liu et al^Citation16 (2014)	January 2008 to December 2010	169	SCC	Cervical and upper thoracic esophageal	NR	DT: 60–68.4 Gy DT: 50.4–54 Gy (ENI)	3D-CRT	99	70
Yamashita et al^Citation14 (2015)	June 2000 to March 2014	239	SCC + other	23/56/41 (upper/middle/lower)	CCRT + CT	IFI: 50.4 Gy/28 F ENI: 50–50.4 Gy/25–28 F	3D-CRT	119	120
Jing et al^Citation13 (2015)	January 2009 to March 2013	137	SCC	11/126 (cervical/thoracic)	CT-RT/CCRT/RT-CT	DT: 50–68.4 Gy 1.8–2.0 Gy/per F	3D-CRT	83	54
Li et al (2015) ASTRO	April 2012 to November 2014	110	SCC	NR	CCRT	GTV: DT 60–66 Gy CTV: DT 50–54 Gy 1.8–2 Gy/per F	IGRT	54	56

Abbreviations: IFI, involved-field irradiation; ENI, elective nodal irradiation; SCC, squamous cell carcinoma; CCRT, concurrent chemoradiotherapy; CT, chemotherapy; F, fraction; DT, dose of total; 3D-CRT, 3-dimensional conformal radiotherapy; NR, no report; RT, radiotherapy; GTV, gross tumor volume; CTV, clinical target volume; IGRT, image-guided radiation therapy; qd, once a day; bid, twice a day.

Figure 2 Forest plots comparing OS and median OS time outcomes for IFI and ENI.

Abbreviations: OS, overall survival; IFI, involved-field irradiation; ENI, elective nodal irradiation; RR, risk ratio; M–H, Mantel–Haenszel; CI, confidence interval; SE, standard error; IV, inverse variance.

Figure 3 Forest plots comparing LCR outcomes for IFI and ENI.

Abbreviations: LCR, local control rate; IFI, involved-field irradiation; ENI, elective nodal irradiation; RR, risk ratio; M–H, Mantel–Haenszel; CI, confidence interval.

Figure 4 Forest plots comparing patterns of treatment failure for IFI and ENI.

Abbreviations: IFI, involved-field irradiation; ENI, elective nodal irradiation; RR, risk ratio; M–H, Mantel–Haenszel; CI, confidence interval.

Figure 5 Forest plots comparing treatment-related toxicities for IFI and ENI.

Abbreviations: IFI, involved-field irradiation; ENI, elective nodal irradiation; RR, risk ratio; M–H, Mantel–Haenszel; CI, confidence interval.

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