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Accelerated or hyperfractionated radiotherapy for esophageal carcinoma: a meta-analysis of randomized controlled trials

Authors Liu YY, Kou CG, Su YY, Zhang YY, You YY, Zhang LL, Wang MH, Fu YL, Ren XJ, Yang YM

Received 19 March 2017

Accepted for publication 12 May 2017

Published 13 June 2017 Volume 2017:10 Pages 2971—2981


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Dr Samir Farghaly

Yingyu Liu,1 Changgui Kou,1 Yingying Su,1 Yangyu Zhang,1 Yueyue You,1 Lili Zhang,1 Mohan Wang,1 Yingli Fu,1 Xiaojun Ren,2 Yanming Yang2

1Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 2Department of Radiotherapy, Second Hospital of Jilin University, Changchun, Jilin, People’s Republic of China

Objective: The goal of this study was to evaluate the efficacy and safety of modified (accelerated and/or hyperfractionated) radiotherapy in the treatment of esophageal carcinoma, compared with conventional radiotherapy.
Methods: Studies published in the PubMed, Cochrane Library, EMBASE, CBM, VIP, CNKI and Wanfang databases in the most recent two decades were searched for use in this meta-analysis. Only randomized controlled trials were included. The heterogeneity analysis and calculation of the pooled odds ratio (OR) were performed using RevMan 5.3 software. The assessment of publication bias and sensitivity analyses was conducted using Stata 13.0 software.
Results: Twenty trials with a total of 1,742 Chinese patients who met the inclusion criteria were included. The pooled results showed that modified radiotherapy improved the response rate compared with conventional schedules (OR =3.90, 95% confidence interval [CI]: 2.47–6.16, P<0.001). Favorable results were observed for the 1-year (OR =2.58, 95% CI: 2.05–3.26, P<0.001), 3-year (OR =2.30, 95% CI: 1.83–2.89, P<0.001) and 5-year (OR =2.36, 95% CI: 1.74–3.21, P<0.001) overall survival and for the 1-year (OR =2.46, 95% CI: 1.72–3.51, P<0.001), 3-year (OR =2.08, 95% CI: 1.49–2.90, P<0.001) and 5-year (OR =2.15, 95% CI: 1.38–3.34, P<0.001) overall local control rate in the modified fractionation radiotherapy group. However, the altered radiotherapy increased the risk of acute radiation esophagitis (OR =1.70, 95% CI: 1.27–2.28, P<0.001) and acute radiation tracheitis (OR =1.47, 95% CI: 1.09–1.99, P=0.01). No significant differences in the risk of esophageal perforation (OR =1.30, 95% CI: 0.51–3.32, P=0.58) or esophagorrhagia (OR =0.88, 95% CI: 0.41–1.88, P=0.74) were found between the two groups.
Conclusion: Chinese patients with squamous cell esophagus carcinomas gained a significant benefit in terms of the response rate, survival and local control rates from the modified fractionation radiotherapy, but also had an increased risk of acute radiation reactions. Otherwise, there was no observed statistically significant difference in terms of early adverse reactions.

Keywords: esophageal carcinoma, radiotherapy, fractionation, meta-analysis

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