Accelerated or hyperfractionated radiotherapy for esophageal carcinoma: a meta-analysis of randomized controlled trials

Figures & data

Figure 1 Search flow diagram for the meta-analysis.

Table 1 Description of baseline characteristics included trials

References	Age (years)	KPS	Lesion length (cm)	Inclusion period*	Quality assessment	Arms	Subjects (n)	Number of fractions	Dose (Gy)	Duration
Sun et al (2006)^Citation20	≤75	≥70	3–10	2003.10–2005.12	A	AF	29	–	50–70	3.6–5.0 weeks
			2–12			CF	29	–	40–70	4.0–7.0 weeks
Liu et al (2013)^Citation21	48–69	≥70	3–10	2003.10–2005.12	B	AF	29	28–33	56–66	28–33 days
			2–12			CF	29	28–33	56–66	37–45 days
Zhuang et al (2009)^Citation22	46–77	>60	–	2003.4–2006.4	B	AF	22	30	60	30 days
						CF	22	30	60	42 days
Peng et al (1996)^Citation23	41–75	>60	≤7	1987.3–9	B	HF	27	34	51	23 days
						CF	27	30–35	60–70	6–7 weeks
Meng (2011)^Citation24	≤70	≥70	–	2004.6–2008.12	B	HF	28	–	61.0–73.2	5–6 weeks
						CF	28	–	60–70	6–7 weeks
Guo et al (2011)^Citation25	47–76	≥70	–	2000.3–2004.3	B	HF	26	–	65	5 weeks
						CF	39	–	70	7 weeks
Chen and Lin (2007)^Citation26	31–76	≥80	≤7	1997.8–1998.10	A	HF	50	66	75.9	45–53 days
						CF	50	33	66	45–52 days
Zhao and Guo (2002)^Citation27	–	≥70	>3	1995.1–1996.5	B	HF	115	–	70	–
						CF	112	–	70	–
Huang and Gao (2001)^Citation28	37–73	≥90	≤9	–	B	HF	26	64	76.8	32 days
						CF	35	35	70	7 weeks
Pei and Zhu (2000)^Citation29	32–77	≥80	≤8	1986.1–1989.4	B	HF	46	70	80.5	49–53 days
						CF	46	35	70.0	47–56 days
Xie and Shi (1999)^Citation30	≤70	≥70	–	–	A	CAHF	11	44	66	29–30 days
						CF	11	38	68.4	52–56 days
Ke et al (2012)^Citation31	38–76	≥70	≤10	2005.1–2007.1	B	CAHF	30	–	66	4.4 weeks
						CF	30	–	66	6.6 weeks
Zhu et al (2010)^Citation32	38–76	≥60	≤10	2004.1–2005.1	B	CAHF	30	–	66	4.4 weeks
						CF	30	–	66	6.6 weeks
Wang (2008)^Citation33	<70	≥60	≤7	2006.7–2007.12	B	CAHF	12	–	66–70	–
						CF	14	–	55–70	5.5–7 weeks
Li et al (2003)^Citation34	<70	≥60	≤8	1990.10–1992.5	B	CAHF	48	–	54	3.5 weeks
						CF	50	–	60–70	6–7 weeks
Zhang et al (2002)^Citation35	≤70	≥70	≤6	1994.10–1998.5	B	CAHF	39	–	60–70	4.5–6 weeks
						CF	37	–	60–66	6–7 weeks
Peng et al (2001)^Citation36	≤70	≥70	≤8	1989.5–1994.12	B	CAHF	106	34–40	51–60	3.3–4.0 weeks
						CF	110	30–35	60–70	6–7 weeks
Fan et al (2000)^Citation37	<70	≥60	≤8	1990.12–1992.7	B	CAHF	48	–	54	3.5 weeks
						CF	48	30–35	60–70	6–7 weeks
Yang (2011)^Citation38	–	≥70	≤7	2003.5–2007.6	A	CAHF + CT	100	40–45	60–67.5	4–4.5 weeks
						CF + CT	100	30–35	60–70	6–7 weeks
Qian et al (2000)^Citation39	<70	>80	<8	1992.6–1993.12	B	CAHF	34	23	65±1.6	34 days
						CF	35	33	65±2.1	45 days

Notes: “–”, not mentioned. Data presented as n, range, or mean ± standard deviation.

* Inclusion periods shown as ‘year.month’ (eg, 2003.10 is October 2003).

Abbreviations: AF, accelerated fractionation; CAHF, continuous accelerated hyperfractionation; CF, conventional fractionation; CT, chemotherapy; HF, hyperfractionation; KPS, Karnofsky performance scale.

Figure 2 Forest plot comparing response rate between modified RT and conventional RT.

Abbreviations: CI, confidence interval; M–H, Mantel–Haenszel; RT, radiotherapy.

Figure 3 Forest plots comparing survival rate between modified RT and conventional RT: (A) 1-year survival; (B) 3-year survival; (C) 5-year survival.

Abbreviations: CI, confidence interval; M–H, Mantel–Haenszel; RT, radiotherapy.

Figure 4 Forest plots comparing local control rate between modified RT and conventional RT: (A) 1-year local control; (B) 3-year local control; (C) 5-year local control.

Abbreviations: CI, confidence interval; M–H, Mantel–Haenszel; RT, radiotherapy.

Figure 5 Forest plots comparing acute radiation reactions between modified RT and conventional RT: (A) acute radiation esophagitis; (B) acute radiation tracheitis.

Abbreviations: CI, confidence interval; M–H, Mantel–Haenszel; RT, radiotherapy.

Figure 6 Forest plots comparing early adverse reactions between modified RT and conventional RT: (A) esophageal perforation; (B) esophagorrhagia.

Abbreviations: CI, confidence interval; M–H, Mantel–Haenszel; RT, radiotherapy.

Table 2 Publication biases assessment of this meta-analysis

Outcome	Egger’s test (t-value)	P-value
Response rate	−0.16	0.88
One-year survival	−0.49	0.64
Three-year survival	−1.03	0.32
Five-year survival	−0.92	0.38
One-year local control	−0.79	0.47
Three-year local control	−0.35	0.74
Five-year local control	−1.20	0.32
Acute esophagitis	2.43	0.03
Acute tracheitis	1.04	0.33
Esophageal perforation	0.33	0.75
Esophagorrhagia	0.23	0.83

SunSPLiuYZYeTRandomized clinical trial on seven-day-per-week continuous accelerated irradiation for patients with esophageal carcinoma: Preliminary report on tumor response and acute toxicityWorld Journal of Gastroenterology200612437047705017109504

 PubMedGoogle Scholar

LiuYZSunSPYeTClinical efficacy of seven-days continuous accelerated irradiation for patients with esophageal carcinomaChinese Journal of Clinical Medicine2013264320323 Chinese

 Google Scholar

ZhuangXBQiaoTKChenWLiRRClinical observation of esophageal carcinoma treated with 7-days continuous accelerated irradiationChinese Journal of Clinical Medicine2009162217219 Chinese

 Google Scholar

PengHGLiuHWangYJJiangHRenKJStudy of hyperfractionated irradiation in the treatment of esophageal carcinomaChinese Journal of Clinical Oncology1996237461463 Chinese

 Google Scholar

MengCYClinical observation of hyperfractionated radiotherapy for esophageal cancer patientsChina Medical Herald2011884143 Chinese

 Google Scholar

GuoHXieCSLiuLHFangYHSunXWThe survival rate and effect of esophageal hyperfractioned radiotherapy and conventional radiotherapyChina Medical Herald20118232627 Chinese

 Google Scholar

ChenJXLinLRLong term efficacy of hyperfractionated radiotherapy for esophageal carcinomaChina Practical Medicine2007233536 Chinese

 Google Scholar

ZhaoYGuoYH115 cases of hyperfractionated radiotherapy for esophageal cancerJournal of Cancer Control and Treatment20021512122 Chinese

 Google Scholar

HuangMDGaoJHThe efficacy and complications of hyperfractionated radiotherapy and conventional fractionated radiotherapy for esophageal cancerChinese Journal of Misdiagnostics20011913451346 Chinese

 Google Scholar

PeiHLZhuYHLong term results of hyperfractionation radiotherapy for esophageal carcinomaChin J Radiat Oncol2000912325 Chinese

 Google Scholar

XieLShiXHAcute toxic effect of accelerated hyperfractionation radiotherapyChinese Journal of Clinical Oncology19992611215 Chinese

 Google Scholar

KeLYHuangBYChengYLTherapeutic effects report of whole course accelerated hyperfractionation for esophageal cancerChina Medical Engineering20122051011 Chinese

 Google Scholar

ZhuGJZhaoXZongCDTherapeutic effects report of whole course accelerated hyperfractionation for esophageal cancerWorld Journal of Tumor201092115117 Chinese

 Google Scholar

WangDClinical observation of conventional radiotherapy and whole course accelerated fractionation radiotherapy for esophageal carcinomaNei Mongol Journal of Traditional Chinese Medicine2008272251 Chinese

 Google Scholar

LiGWGuoYZGuoYXAccelerated fractionation radiotherapy for esophageal carcinomaHenan Medical Research20031214547 Chinese

 Google Scholar

ZhangBHSuCLLiuHYZhangYYZhangYLGongLPAccelerated hypertractionation radiotherapy using the field-in-field technique for upper thoracic esophageal carcinomaChon J Radiat Oncol2002112101103 Chinese

 Google Scholar

PengKGDuanSMLiuHJiangHWangYJWhole course accelerated hyperfractionation radiotherapy for esophageal carcinomaChinese Journal of Radiation Oncology20011027779 Chinese

 Google Scholar

FanRTGuoYXGuoYZLiGWShiGZToxic effect and complication of accelerated hyperfractionation for esophageal carcinomaChinese Journal of Cancer2000196597599 Chinese

 Google Scholar

YangZWhole course accelerated hyperfractionation with three dimensional conformal radiotherapy for esophageal carcinomaMedical Information2011244758759 Chinese

 Google Scholar

QianMHaoJFLiuXQWeiGSLong term results of accelerated hyperfraction field-in-field radiotherapy for middle esophageal carcinomaChinese Journal of Clinical Oncology and Rehabilitation2000753637 Chinese

 Google Scholar