Can involved-field irradiation replace elective nodal irradiation in chemoradiotherapy for esophageal cancer? A systematic review and meta-analysis

Abstract

Chemoradiotherapy is the most common treatment for inoperable esophageal cancer. However, there is no consensus on the delineation of the clinical target volume. Elective nodal irradiation (ENI) is recommended for inoperable esophageal cancer. A few studies have reported a decrease in the incidence of radiation-related toxicity of involved-field irradiation (IFI) for esophageal cancer. A systematic review and pooled analysis were performed to determine whether IFI in definitive chemoradiotherapy was more beneficial than ENI for esophageal cancer. The results showed no significant differences in the overall survival and local control rates between the IFI and ENI arms. Meanwhile, the incidences of esophageal and lung toxicities were significantly decreased in the IFI arm. These results suggest that IFI is a feasible treatment option for locally advanced esophageal cancer, especially to minimize irradiation-related toxicity.

Keywords: chemoradiotherapy; elective nodal irradiation; esophageal cancer; involved-field irradiation; meta-analysis.

Figure 1

Selection criteria of the included studies. Abbreviations: IFRT, involved-field radiotherapy; ENI, elective nodal irradiation; ASTRO, American Society for Radiation Oncology.

Figure 2

Forest plots comparing OS and median OS time outcomes for IFI and ENI. Abbreviations: OS, overall survival; IFI, involved-field irradiation; ENI, elective nodal irradiation; RR, risk ratio; M–H, Mantel–Haenszel; CI, confidence interval; SE, standard error; IV, inverse variance.

Figure 3

Forest plots comparing LCR outcomes for IFI and ENI. Abbreviations: LCR, local control rate; IFI, involved-field irradiation; ENI, elective nodal irradiation; RR, risk ratio; M–H, Mantel–Haenszel; CI, confidence interval.

Figure 4

Forest plots comparing patterns of treatment failure for IFI and ENI. Abbreviations: IFI, involved-field irradiation; ENI, elective nodal irradiation; RR, risk ratio; M–H, Mantel–Haenszel; CI, confidence interval.

Figure 5

Forest plots comparing treatment-related toxicities for IFI and ENI. Abbreviations: IFI, involved-field irradiation; ENI, elective nodal irradiation; RR, risk ratio; M–H, Mantel–Haenszel; CI, confidence interval.