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TOPLINE:

In patients with inoperable locally advanced esophageal cancer who received definitive concurrent chemoradiotherapy, a higher radiation dose (≥ 59.4 Gy) did not improve survival compared with the standard dose (50.0 Gy/50.4 Gy), but the higher dose did increase grades ≥ 3 treatment-related adverse events (AEs), according to a meta-analysis of randomized trials.

METHODOLOGY:

• Definitive concurrent chemoradiotherapy is the standard nonoperative treatment for locally advanced esophageal cancer, but the optimal radiation dose remains uncertain.
• Researchers conducted a meta-analysis of six randomized clinical trials, which included 1722 patients with locally advanced esophageal cancer who received either high-dose radiotherapy (≥ 59.4 Gy; n = 862) or standard-dose radiotherapy (50.0 Gy/50.4 Gy; n = 860).
• The primary endpoint was overall survival, and the secondary endpoints were progression-free survival (PFS), locoregional PFS, distant metastasis, grades ≥ 3 treatment-related AEs, and treatment-related deaths.
• The median follow-up duration in the studies ranged from 16.4 to 64.6 months.

TAKEAWAY:

• High-dose radiotherapy did not improve rates of 3-year overall survival (risk ratio [RR], 1.00; P = .990), 3-year PFS (RR, 0.96; P = .320), or 3-year locoregional PFS (RR, 0.88; P = .204) compared with standard-dose radiotherapy. Both groups had similar rates of distant metastasis (odds ratio [OR], 0.91; P = .645).
• Hazards for death or disease progression were also similar between the groups — in terms of overall survival (pooled HR, 0.99; P =.854) and PFS (pooled HR, 0.94; P = .628) — indicating no survival benefit with higher doses.
• High-dose radiotherapy significantly increased patients’ risk for grade ≥ 3 treatment-related AEs (OR, 1.26; P = .025), though not for treatment-related deaths (OR, 1.57; P = .068).
• Subgroup analyses based on radiation techniques (looking at the effect of more modern techniques), histology, target size, and dose-escalation also indicated no survival benefit but an increased incidence of grade ≥ 3 treatment-related AEs in those who received high-dose radiotherapy.

IN PRACTICE:

For patients with inoperable locally advanced esophageal cancer receiving definitive concurrent chemoradiotherapy, standard-dose radiotherapy (50 Gy or 50.4 Gy) had similar treatment effects but lower grade ≥ 3 treatment-related adverse effects compared with the high-dose radiotherapy (≥ 59.4 Gy), the authors concluded. “The results lay to rest the controversy of whether radiotherapy dose escalation brings benefits.”

SOURCE:

The study, led by Rui Li, MD, Ningbo No. 2 Hospital, Ningbo, China, was published online in Radiotherapy and Oncology.

LIMITATIONS:

The analysis included relatively few eligible randomized clinical trials and a small total sample size. Information about tumor position and radiotherapy volumes was incomplete in some included studies. Additionally, individual patient data were not analyzed.

DISCLOSURES:

The study received support through grants from the Shenzhen Medical Research Fund, the National Natural Science Foundation of China, the Tianjin Key Medical Discipline Construction Project, the National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, and the Ningbo Top Medical and Health Research Program. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.