High versus Standard Radiation Dose of Definitive Concurrent Chemoradiotherapy for Esophageal Cancer: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
A partir d'une revue systématique de la littérature publiée jusqu'en juillet 2022 (4 essais randomisés, 1 014 patients), cette méta-analyse évalue l'efficacité, du point de vue de la survie globale, et la toxicité d'une forte dose de rayonnement par rapport à la dose standard de rayonnement d'une radiochimiothérapie concomitante définitive chez des patients atteints d'un cancer de l'oesophage
Résumé en anglais
OBJECTIVES: Compare the efficacy and safety of high vs. standard radiation dose of definitive concurrent chemoradiotherapy (dCCRT) for esophageal cancer (EC).
METHODS AND MATERIALS: This meta-analysis is registered in PROSPERO, and it was followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Eligible randomized clinical trials (RCTs) comparing high dose (HD;≥59.4Gy/1.8Gy) and standard doses (SD; 50Gy/2Gy or 50.4Gy/1.8Gy) were identified on electronic databases. STATA16.0 was used for statistical analysis. A meta-analysis was performed to compare treatment effect and toxicity.
RESULTS: Four articles with a total of 1014 patients were finally included. The results showed that the two groups had similar 1-, 2-, and 3-year OS rates (RR =1.08, 95% CI = 0.90-1.30, P = 0.395; RR =1.07, 95% CI = 0.95-1.20, P = 0.272; RR = 1.06, 95% CI =0.97-1.17, P =0.184; respectively) and 2-, and 3-year locoregional progression-free survival (LRPFS) (RR = 0.95, 95% CI = 0.81-1.10, P = 0.478; RR = 0.97, 95% CI =0.85-1.11, P =0.674; respectively). The HD-RT group had higher grade ≥ 3 treatment-related toxicities (OR =1.35, 95% CI = 1.03-1.77, P = 0.029) and treatment-related deaths rates (OR =1.85, 95% CI = 1.04-3.28, P = 0.036) compared with the SD-RT group. Results of subgroup analysis also indicated that HD could not bring benefit compared to SD, even with modern radiotherapy techniques.
CONCLUSION: SD-RT had similar treatment effect but lower Grade ≥ 3 treatment-related toxicities rates compared with the HD-RT. Therefore, SD (50Gy/2Gy or 50.4Gy/1.8Gy) should be considered as the recommended dose in dCCRT for EC. Further RCTs are needed to verify our conclusions.
