Comparison of clinical efficacy of neoadjuvant chemoradiotherapy between lower and higher radiation dose for carcinoma of the esophagus and gastroesophageal junction: a systematic review
Abstract
BACKGROUND
Neoadjuvant concurrent chemoradiotherapy (nCRT) plus surgery has been a standard treatment for locoregionally advanced esophageal cancer and carcinoma of the gastroesophageal junction (EC/GEJ), but an optimal preoperative radiation dose is still unclear.
PURPOSE
We performed this systematic review to explore the treatment efficacy and toxicity of different radiation dose levels and find an optimal dose-fractionation strategy in EC/GEJ patients receiving nCRT.
METHODS
Embase and Ovid Medline were searched for articles involving operable squamous and adenocarcinoma of the esophagus and GEJ receiving nCRT up to a dose of 50.4 Gy/28 fractions published until July 2019 when the search was performed. Physical dose distributions were converted to biologically equivalent dose (BED), which was described in units of Gy (alpha/beta). Pooled rates of overall survival (OS), progression-free survival (PFS), failure patterns, and toxicities were compared between lower-dose (BED ≤48.85 Gy10, LDRT) and higher-dose (BED >48.85 Gy10, HDRT) radiotherapy for patients treated with nCRT.
RESULTS
A total of 110 studies with 7,577 EC/GEJ patients receiving nCRT were included in this pooled analysis. Both the PFS and OS rates of patients receiving LDRT were significantly higher than those receiving HDRT. Patients receiving LDRT had improved safety regarding treatment-related adverse events and lower distant failure rates than patients receiving HDRT. Utilization of modern RT techniques…
How strong is the evidence?
Evidence Hub reads this as a systematic review. 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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