What is the optimal radiation dose for non-operable esophageal cancer? Dissecting the evidence in a meta-analysis
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Yong Chen1,*, Hui-Ping Zhu2,3,*, Tao Wang1,*, Chang-Jiang Sun1, Xiao-Lin Ge2, Ling-Feng Min4, Xian-Wen Zhang1, Qing-Qing Jia1, Jie Yu1, Jian-Qi Yang1, Heike Allgayer5, Mohammed L. Abba5, Xi-Zhi Zhang1 and Xin-Chen Sun2
1Department of Medical Oncology, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
2Department of Radiotherapy, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
3Department of Medical Oncology, Zhangjiagang First People's Hospital, Zhangjiagang, Jiangsu, China
4Department of Respiratory Medicine, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
5Department of Experimental Surgery-Cancer Metastasis, Medical Faculty Mannheim, University of Heidelberg, Germany and Centre for Biomedicine and Medical Technology, Medical Faculty Mannheim, University of Heidelberg, Germany
*These authors contributed equally to this work
Xin-Chen Sun, email: firstname.lastname@example.org
Mohammed L. Abba, email: Mohammed.Abba@medma.uni-heidelberg.de
Xi-Zhi Zhang, email: email@example.com
Keywords: esophageal cancer, radiation dose, meta-analysis, chemoradiotherapy, survival benefit
Received: January 25, 2017 Accepted: June 05, 2017 Published: June 28, 2017
The standard radiation dose 50.4 Gy with concurrent chemotherapy for localized inoperable esophageal cancer as supported by INT-0123 trail is now being challenged since a radiation dose above 50 Gy has been successfully administered with an observable dose–response relationship and insignificant untoward effects. Therefore, to ascertain the treatment benefits of different radiation doses, we performed a meta-analysis with 18 relative publications. According to our findings, a dose between 50 and 70 Gy appears optimal and patients who received ≥ 60 Gy radiation had a significantly better prognosis (pooled HR = 0.78, P = 0.004) as compared with < 60 Gy, especially in Asian countries (pooled HR = 0.75, P = 0.003). However, contradictory results of treatment benefit for ≥ 60 Gy were observed in two studies from Western countries, and the pooled treatment benefit of ≥ 60 Gy radiation was inconclusive (pooled HR = 0.86, P = 0.64). There was a marginal benefit in locoregional control in those treated with high dose (> 50.4/51 Gy) radiation when compared with those treated with low dose (≤ 50.4/51 Gy) radiation (pooled OR = 0.71, P = 0.06). Patients that received ≥ 60 Gy radiation had better locoregional control (OR = 0.29, P = 0.001), and for distant metastasis control, neither the > 50.4 Gy nor the ≥ 60 Gy treated group had any treatment benefit as compared to the groups that received ≤ 50.4 Gy and < 60 Gy group respectively. Taken together, a dose range of 50 to 70 Gy radiation with CCRT is recommended for non-operable EC patients. A dose of ≥ 60 Gy appears to be better in improving overall survival and locoregional control, especially in Asian countries, while the benefit of ≥ 60 Gy radiation in Western countries still remains controversial.
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