Optimal radiation dosing in concurrent neoadjuvant chemoradiation for resectable esophageal cancer: A meta-analysis

Steven Engel, Adam Awerbuch, Deukwoo Kwon, Omar Picado, Raphael Yechieli, Danny Yakoub, Lorraine Portelance

Research output: Contribution to journalArticle

Abstract

Background: This is the first meta-analysis to study optimal radiation dose in the setting of concurrent neoadjuvant chemoradiotherapy (cnCRT) for esophageal cancer (EC). We sought to compare outcomes between high dose radiotherapy (HDRT) [>48.85 Gy biologically effective dose (BED)] group and low dose radiotherapy (LDRT) (≤48.85 Gy BED) for patients with EC receiving cnCRT. Methods: Medline, Embase, and Cochrane databases were searched independently by two members of our team on August 07, 2017. Articles were screened using Covidence. Study quality was assessed via CONSORT. Eligible studies had to be randomized controlled trials (RCT) comparing cnCRT vs. surgery alone in full-text English. Those with induction or sequential chemoradiotherapy were excluded. We captured data points including radiation dose, hazard ratios (HRs) for overall survival (OS), and treatment-related mortality (TRM). We analyzed HRs for OS and risk ratio (RR) for TRM and corresponding 95% confidence interval (CI) as the summary statistic. We used both fixed- and random-effects models in the presence of heterogeneity. The primary outcome was OS; secondary endpoint was treatment related mortality (TRM). We compared outcomes by HDRT vs. LDRT. To minimize chemotherapy heterogeneity, we performed a pre-planned analysis excluding the CROSS trial. Results: The eleven included studies contained a total of 1,697 patients. Eight hundred forty-eight were randomized into the cnCRT. Of these 848 patients, 287 received HDRT and 561 received LDRT. HR for OS was not statistically different between LDRT (HR 0.67; 95% CI, 0.55-0.8) and HDRT (HR 0.68; 95% CI, 0.45-0.91). Excluding the CROSS trial, there was still no difference in outcomes between LDRT and HDRT. TRM was similar between LDRT and HDRT. Conclusions: With no difference in OS or TRM between LDRT and HDRT, 48.85 Gy BED cnCRT may be a sufficient radiation dose for cnCRT for patients with EC fit for surgery.

Original languageEnglish (US)
Pages (from-to)391-399
Number of pages9
JournalJournal of Gastrointestinal Oncology
Volume10
Issue number3
DOIs
StatePublished - Jan 1 2019

Fingerprint

Esophageal Neoplasms
Meta-Analysis
Radiotherapy
Radiation
Chemoradiotherapy
Survival
Mortality
Confidence Intervals
Therapeutics
Randomized Controlled Trials
Odds Ratio

All Science Journal Classification (ASJC) codes

  • Oncology
  • Gastroenterology

Cite this

Optimal radiation dosing in concurrent neoadjuvant chemoradiation for resectable esophageal cancer : A meta-analysis. / Engel, Steven; Awerbuch, Adam; Kwon, Deukwoo; Picado, Omar; Yechieli, Raphael; Yakoub, Danny; Portelance, Lorraine.

In: Journal of Gastrointestinal Oncology, Vol. 10, No. 3, 01.01.2019, p. 391-399.

Research output: Contribution to journalArticle

Engel, Steven ; Awerbuch, Adam ; Kwon, Deukwoo ; Picado, Omar ; Yechieli, Raphael ; Yakoub, Danny ; Portelance, Lorraine. / Optimal radiation dosing in concurrent neoadjuvant chemoradiation for resectable esophageal cancer : A meta-analysis. In: Journal of Gastrointestinal Oncology. 2019 ; Vol. 10, No. 3. pp. 391-399.
@article{f207b8cc06474f949940d2e1e15a1f9a,
title = "Optimal radiation dosing in concurrent neoadjuvant chemoradiation for resectable esophageal cancer: A meta-analysis",
abstract = "Background: This is the first meta-analysis to study optimal radiation dose in the setting of concurrent neoadjuvant chemoradiotherapy (cnCRT) for esophageal cancer (EC). We sought to compare outcomes between high dose radiotherapy (HDRT) [>48.85 Gy biologically effective dose (BED)] group and low dose radiotherapy (LDRT) (≤48.85 Gy BED) for patients with EC receiving cnCRT. Methods: Medline, Embase, and Cochrane databases were searched independently by two members of our team on August 07, 2017. Articles were screened using Covidence. Study quality was assessed via CONSORT. Eligible studies had to be randomized controlled trials (RCT) comparing cnCRT vs. surgery alone in full-text English. Those with induction or sequential chemoradiotherapy were excluded. We captured data points including radiation dose, hazard ratios (HRs) for overall survival (OS), and treatment-related mortality (TRM). We analyzed HRs for OS and risk ratio (RR) for TRM and corresponding 95{\%} confidence interval (CI) as the summary statistic. We used both fixed- and random-effects models in the presence of heterogeneity. The primary outcome was OS; secondary endpoint was treatment related mortality (TRM). We compared outcomes by HDRT vs. LDRT. To minimize chemotherapy heterogeneity, we performed a pre-planned analysis excluding the CROSS trial. Results: The eleven included studies contained a total of 1,697 patients. Eight hundred forty-eight were randomized into the cnCRT. Of these 848 patients, 287 received HDRT and 561 received LDRT. HR for OS was not statistically different between LDRT (HR 0.67; 95{\%} CI, 0.55-0.8) and HDRT (HR 0.68; 95{\%} CI, 0.45-0.91). Excluding the CROSS trial, there was still no difference in outcomes between LDRT and HDRT. TRM was similar between LDRT and HDRT. Conclusions: With no difference in OS or TRM between LDRT and HDRT, 48.85 Gy BED cnCRT may be a sufficient radiation dose for cnCRT for patients with EC fit for surgery.",
author = "Steven Engel and Adam Awerbuch and Deukwoo Kwon and Omar Picado and Raphael Yechieli and Danny Yakoub and Lorraine Portelance",
year = "2019",
month = "1",
day = "1",
doi = "10.21037/jgo.2019.01.02",
language = "English (US)",
volume = "10",
pages = "391--399",
journal = "Journal of Gastrointestinal Oncology",
issn = "2078-6891",
publisher = "Pioneer Bioscience Publishing Company (PBPC)",
number = "3",

}

TY - JOUR

T1 - Optimal radiation dosing in concurrent neoadjuvant chemoradiation for resectable esophageal cancer

T2 - A meta-analysis

AU - Engel, Steven

AU - Awerbuch, Adam

AU - Kwon, Deukwoo

AU - Picado, Omar

AU - Yechieli, Raphael

AU - Yakoub, Danny

AU - Portelance, Lorraine

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: This is the first meta-analysis to study optimal radiation dose in the setting of concurrent neoadjuvant chemoradiotherapy (cnCRT) for esophageal cancer (EC). We sought to compare outcomes between high dose radiotherapy (HDRT) [>48.85 Gy biologically effective dose (BED)] group and low dose radiotherapy (LDRT) (≤48.85 Gy BED) for patients with EC receiving cnCRT. Methods: Medline, Embase, and Cochrane databases were searched independently by two members of our team on August 07, 2017. Articles were screened using Covidence. Study quality was assessed via CONSORT. Eligible studies had to be randomized controlled trials (RCT) comparing cnCRT vs. surgery alone in full-text English. Those with induction or sequential chemoradiotherapy were excluded. We captured data points including radiation dose, hazard ratios (HRs) for overall survival (OS), and treatment-related mortality (TRM). We analyzed HRs for OS and risk ratio (RR) for TRM and corresponding 95% confidence interval (CI) as the summary statistic. We used both fixed- and random-effects models in the presence of heterogeneity. The primary outcome was OS; secondary endpoint was treatment related mortality (TRM). We compared outcomes by HDRT vs. LDRT. To minimize chemotherapy heterogeneity, we performed a pre-planned analysis excluding the CROSS trial. Results: The eleven included studies contained a total of 1,697 patients. Eight hundred forty-eight were randomized into the cnCRT. Of these 848 patients, 287 received HDRT and 561 received LDRT. HR for OS was not statistically different between LDRT (HR 0.67; 95% CI, 0.55-0.8) and HDRT (HR 0.68; 95% CI, 0.45-0.91). Excluding the CROSS trial, there was still no difference in outcomes between LDRT and HDRT. TRM was similar between LDRT and HDRT. Conclusions: With no difference in OS or TRM between LDRT and HDRT, 48.85 Gy BED cnCRT may be a sufficient radiation dose for cnCRT for patients with EC fit for surgery.

AB - Background: This is the first meta-analysis to study optimal radiation dose in the setting of concurrent neoadjuvant chemoradiotherapy (cnCRT) for esophageal cancer (EC). We sought to compare outcomes between high dose radiotherapy (HDRT) [>48.85 Gy biologically effective dose (BED)] group and low dose radiotherapy (LDRT) (≤48.85 Gy BED) for patients with EC receiving cnCRT. Methods: Medline, Embase, and Cochrane databases were searched independently by two members of our team on August 07, 2017. Articles were screened using Covidence. Study quality was assessed via CONSORT. Eligible studies had to be randomized controlled trials (RCT) comparing cnCRT vs. surgery alone in full-text English. Those with induction or sequential chemoradiotherapy were excluded. We captured data points including radiation dose, hazard ratios (HRs) for overall survival (OS), and treatment-related mortality (TRM). We analyzed HRs for OS and risk ratio (RR) for TRM and corresponding 95% confidence interval (CI) as the summary statistic. We used both fixed- and random-effects models in the presence of heterogeneity. The primary outcome was OS; secondary endpoint was treatment related mortality (TRM). We compared outcomes by HDRT vs. LDRT. To minimize chemotherapy heterogeneity, we performed a pre-planned analysis excluding the CROSS trial. Results: The eleven included studies contained a total of 1,697 patients. Eight hundred forty-eight were randomized into the cnCRT. Of these 848 patients, 287 received HDRT and 561 received LDRT. HR for OS was not statistically different between LDRT (HR 0.67; 95% CI, 0.55-0.8) and HDRT (HR 0.68; 95% CI, 0.45-0.91). Excluding the CROSS trial, there was still no difference in outcomes between LDRT and HDRT. TRM was similar between LDRT and HDRT. Conclusions: With no difference in OS or TRM between LDRT and HDRT, 48.85 Gy BED cnCRT may be a sufficient radiation dose for cnCRT for patients with EC fit for surgery.

UR - http://www.scopus.com/inward/record.url?scp=85066925185&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85066925185&partnerID=8YFLogxK

U2 - 10.21037/jgo.2019.01.02

DO - 10.21037/jgo.2019.01.02

M3 - Article

AN - SCOPUS:85066925185

VL - 10

SP - 391

EP - 399

JO - Journal of Gastrointestinal Oncology

JF - Journal of Gastrointestinal Oncology

SN - 2078-6891

IS - 3

ER -