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. 2021 Jan 7:10:604657.
doi: 10.3389/fonc.2020.604657. eCollection 2020.

Long-Term Survival in Nonsurgical Esophageal Cancer Patients Who Received Consolidation Chemotherapy Compared With Patients Who Received Concurrent Chemoradiotherapy Alone: A Systematic Review and Meta-Analysis

Xiaojie Xia  1 , Zeyuan Liu  2 , Qin Qin  1 , Xiaoke Di  1 , Zhaoyue Zhang  1 , Xinchen Sun  2 , Xiaolin Ge  1
Affiliations

Long-Term Survival in Nonsurgical Esophageal Cancer Patients Who Received Consolidation Chemotherapy Compared With Patients Who Received Concurrent Chemoradiotherapy Alone: A Systematic Review and Meta-Analysis

Xiaojie Xia et al. Front Oncol. .

Abstract

Background: Concurrent chemoradiotherapy (CCRT) is the standard treatment for nonsurgical esophageal cancer (EC). However, esophageal cancer patients receiving CCRT alone are still unsatisfactory in terms of local control and overall survival (OS) benefit. Clinicians generally add consolidation chemotherapy (CCT) after CCRT. It remains controversial whether CCT following CCRT is beneficial for esophageal cancer. We, therefore, undertook a meta-analysis to assess the need for CCT in inoperable esophageal cancer.

Materials and methods: We combed PubMed, Embase, Cochrane Library, Web of Science, and CNKI for relevant published articles up to July 2020 that compared CCRT plus CCT to CCRT alone for patients with nonsurgical EC. Our primary endpoint was OS and progression-free survival (PFS), and the secondary endpoint was treatment toxicity. We analyzed the hazard ratio (HR) to estimate the time-to-event data and the odds ratio (OR) to compare the treatment-related effect. To assess heterogeneity, we performed the I2 test and examined publication bias using funnel plots analysis.

Results: The 11 retrospective studies involved 2008 patients. Of these 2008 patients, 1018 received CCRT plus CCT, and 990 received CCRT. Compared to CCRT alone, CCT after CCRT did not improve disease control rate (DCR) (OR 1.66; 95% CI 0.53-5.15, p=0.384) and objective response rate (ORR) (OR 1.44; 95% CI 0.62-3.35, p=0.393). However, OS (HR 0.72; 95% CI 0.59-0.86, p < 0.001) and PFS (HR 0.61; 95% CI 0.44-0.84, p=0.003) did increase. Our results show that CCT plus CCRT had a clear survival advantage over CCRT alone. The risk of treatment toxicity did not increase for EC patients who received CCT.

Conclusion: CCT after CCRT significantly increases OS and PFS in patients with nonsurgical EC and could provide them remarkable survival benefits. The results provide an evidence-based framework for the use of CCT after CCRT.

Keywords: chemoradiotherapy; consolidation chemotherapy; esophageal cancer; meta-analysis; toxicity.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study selection process.
Figure 2
Figure 2
(A) Meta-analysis of the associated HRs of OS for CCRT–CCT compared with CCRT alone. (B) Subgroup analysis of the associated HRs of OS for CCRT–CCT compared with CCRT alone. HR, hazard ratio; OS, overall survival; 95% CI, 95% confidence interval; CCRT–CCT, consolidation chemotherapy following concurrent chemoradiotherapy; CCRT alone, only concurrent chemoradiotherapy.
Figure 3
Figure 3
Meta-analysis of the associated HRs of PFS for CCRT–CCT compared with CCRT alone. HR, hazard ratio; PFS, progression-free survival; CCRT–CCT, consolidation chemotherapy following concurrent chemoradiotherapy; CCRT alone only concurrent chemoradiotherapy.
Figure 4
Figure 4
(A) Meta-analysis of the associated ORs of DCR for CCRT–CCT compared with CCRT alone. (B) Meta-analysis of the associated ORs of ORR for CCRT–CCT compared with CCRT alone. OR, odds ratio; DCR, disease control rate; ORR, objective response rate; 95% CI, 95% confidence interval; CCRT–CCT, consolidation chemotherapy following concurrent chemoradiotherapy; CCRT alone, only concurrent chemoradiotherapy.
Figure 5
Figure 5
Sensitivity analysis of HRs of OS. HR, hazard ratio.
Figure 6
Figure 6
Funnel plot of publication bias for OS.
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