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Cheng YJ, Jing SW, Zhu LL, Wang J, Wang L, Liu Q, Yang CR, Wang Y, Cao F, Jiao WP, Wu YJ. Comparison of elective nodal irradiation and involved-field irradiation in esophageal squamous cell carcinoma: a meta-analysis. JOURNAL OF RADIATION RESEARCH 2018; 59:604-615. [PMID: 30085197 PMCID: PMC6151636 DOI: 10.1093/jrr/rry055] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/27/2018] [Indexed: 05/07/2023]
Abstract
It remains controversial whether radical radiotherapy in patients with esophageal squamous cell carcinoma (ESCC) still requires elective nodal irradiation (ENI), or only involved-field irradiation (IFI). In this study, a meta-analysis was conducted to compare ENI and IFI in the treatment of ESCC, in order to provide guidance for clinical practice. Literature on the use of ENI and IFI in the treatment of ESCC was retrieved, and the last access date was 31 December 2017. A meta-analysis was performed to evaluate the relative advantages and disadvantages of using ENI and IFI. Ten studies, involving a total of 1348 patients, were included in this analysis; of these, 605 patients underwent radiotherapy only, and 743 underwent radiochemotherapy. There was no significant difference in the 1-, 2- or 3-year local control rates between ENI and IFI, or in the 1-, 2- or 3-year overall survival rates. However, the incidences of ≥Grade 3 acute esophagitis and pneumonia were significantly lower in the IFI group. There were no differences in the rates of ≥Grade 3 myelosuppression or of out-field recurrence or metastasis between these two groups. Thus, neither local control rates nor overall survival rates differed significantly between the ENI and IFI groups, but in the latter group, incidences of severe radiation esophagitis and pneumonia were significantly lower. IFI was not associated with an increase in out-field recurrence or metastasis.
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Affiliation(s)
- Yun-jie Cheng
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Shao-wu Jing
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Ling-ling Zhu
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Jun Wang
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Long Wang
- Department of Family and Consumer Sciences, California State University, Long Beach, 1250 Bellflower Blvd, Long Beach, California, USA
| | - Qing Liu
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Cong-rong Yang
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Yi Wang
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Feng Cao
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Wen-peng Jiao
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Ya-jing Wu
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
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Deng W, Lin SH. Advances in radiotherapy for esophageal cancer. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:79. [PMID: 29666802 DOI: 10.21037/atm.2017.11.28] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Esophageal cancer is a common type of malignancy worldwide and usually requires multidisciplinary care. Radiotherapy plays an important part in management of the disease. During the past few years, researchers have made much progress about radiotherapy for esophageal cancer, which was revealed in every aspect of clinical practice. Neoadjuvant chemoradiotherapy remains the standard treatment for locally advanced esophageal cancer, whereas neoadjuvant chemotherapy appears to show less toxicities and non-inferior prognosis. What's more, definitive chemoradiotherapy could be an option for non-surgical candidates and good responders to chemoradiotherapy. Advances in radiation techniques result in higher conformity, homogeneity, more normal tissue sparing and less treatment time. Promising prognoses and less toxicities were also seen in advanced techniques. As radiation dose higher than 50 Gy obtains better local control and survival, simultaneously integrated boost is designed to increase primary tumor dosage and keep prophylactic dose to subclinical areas. Elective nodal irradiation brings about better local control but do not show advantages in survival compared with involved field irradiation (IFI). As a trend, more tolerable chemoradiotherapy regimen would be taken into account in dealing with elderly patients.
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Affiliation(s)
- Wei Deng
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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