Late toxicity and health-related quality of life following definitive chemoradiotherapy for esophageal cancer: a systematic review and meta-analysis
Abstract
BACKGROUND
Definitive chemoradiotherapy (dCRT) is a treatment option with curative intent for patients with esophageal cancer that could result in late toxicities and impact health-related quality of life (HRQoL). This study aimed to review the literature and perform a meta-analysis to investigate the effect of dCRT on late toxicities and HRQoL in esophageal cancer.
METHODS
A systematic search was performed in MEDLINE, EMBASE and PsychINFO. Prospective phase II and III clinical trials, population-based studies and retrospective chart reviews investigating late toxicity and/or HRQoL after dCRT (≥50 Gy) were included. HRQoL outcomes were analyzed using linear mixed effect models with restricted cubic spline transformation. HRQoL changes of ≥10 points were considered clinically relevant. Risk of toxicities was calculated using number of events and the total study population.
RESULTS
Among 41 included studies 10 assessed HRQoL and 31 late toxicity. Global health status remained stable over time and improved after 36 months compared to baseline (mean change +11). Several tumor-specific symptoms, including dysphagia, eating restrictions and pain, improved after six months compared to baseline. Dyspnea worsened after six months (mean change +16 points) compared to baseline. Risk of any late toxicity was 48% (95% confidence interval [CI] 33-64%). Late toxicity risk of any grade for the esophagus was 17% (95% CI 12-21%), pulmonary 21% (95% CI 11-31%), cardiac 12% (95% CI 6-17%) and…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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