A Meta-Analysis of Concurrent Chemoradiotherapy for Advanced Esophageal Cancer

Li-Li Zhu, Ling Yuan, Hui Wang, Lin Ye, Gui-Ying Yao, Cui Liu, Niu-Niu Sun, Xiao-Jing Li, Shi-Cong Zhai, Ling-Juan Niu, Jun-Bo Zhang, Hong-Long Ji, Xiu-Min Li, Li-Li Zhu, Ling Yuan, Hui Wang, Lin Ye, Gui-Ying Yao, Cui Liu, Niu-Niu Sun, Xiao-Jing Li, Shi-Cong Zhai, Ling-Juan Niu, Jun-Bo Zhang, Hong-Long Ji, Xiu-Min Li

Abstract

Background: Concurrent chemoradiotherapy is a standard treatment for local advanced esophageal cancer, but the outcomes are controversial. Our goals were to compare the therapeutic effects of concurrent chemoradiotherapy and radiotherapy alone in local advanced esophageal cancer using meta-analysis.

Methods: MEDLINE, EMBASE and the Cochrane library were searched for studies comparing chemoradiotherapy with radiotherapy alone for advanced esophageal cancer. Only randomized controlled trials were included, and extracted data were analyzed with Review Manager Version 5.2. The pooled relative risks (RR) and their 95% confidence intervals (CI) were calculated for statistical analysis.

Results: Nine studies were included. Of 1,135 cases, 612 received concurrent chemoradiotherapy and 523 were treated with radiotherapy alone. The overall response rate (complete remission and partial remission) was 93.4% for concurrent chemoradiotherapy and 83.7% for radiotherapy alone (P = 0.05). The RR values of 1-year, 3-year, and 5-year survival rates were 1.14 (95% CI: 1.04 - 1.24, P = 0.006), 1.66 (95% CI: 1.34 - 2.06, P < 0.001), and 2.43 (95% CI: 1.63 - 3.63, P < 0.001), respectively. The RR value of the merged occurrence rate of acute toxic effects was 2.34 (95% CI: 1.90 - 2.90, P <0.001). There was no difference in the incidence of late toxic effects, which had an RR value of 1.21 (95% CI: 0.96 - 1.54, P = 0.11). The RR level of persistence and recurrence was 0.71 (95% CI: 0.62 - 0.81, P <0.001), and for the distant metastasis rate, the RR value was 0.79 (95% CI: 0.61 - 1.02, P = 0.07).

Conclusions: Concurrent chemoradiotherapy significantly improved overall survival rate, reduced the risk of persistence and recurrence, but had little effect on the primary tumor response, and increased the occurrence of acute toxic effects.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Forest plot comparing primary tumor…
Fig 1. Forest plot comparing primary tumor response rates for the CCRT group and the RT alone group.
The blue squares represent study-specific risk difference (RD), the horizontal line represents 95% confidence intervals (CIs), and the black diamond represents summary risk difference.
Fig 2. Forest plot comparing survival rates…
Fig 2. Forest plot comparing survival rates for the CCRT group and the RT alone group.
The blue squares represent study-specific relative risks (RR), the horizontal lines represent 95% CIs, and the black diamonds represent the summary of RR. (A) Comparison of 1-year survival rate. (B) Comparison of 3-year survival rate. (C) Comparison of 5-year survival rate.
Fig 3. Forest plots comparing rates of…
Fig 3. Forest plots comparing rates of toxic effects for the CCRT group and RT alone group.
(A) Rate of acute toxic effects. (B) Rate of late toxic effects.
Fig 4. Forest plots comparing rates of…
Fig 4. Forest plots comparing rates of (A) persistence and recurrence, and (B) distant metastasis, between the CCRT group and RT alone group.
Fig 5. Funnel plot indicating no evidence…
Fig 5. Funnel plot indicating no evidence of heterogeneity between trials for distant metastasis rate.
RR values included in the meta-analysis are indicated on the abscissa axis, and the SE (Log OR) values are indicated on the ordinate axis. The impact of publication bias was assessed by observing the symmetry.

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