3559 - Radiotherapy Combined with Systemic Therapy vs. Systemic Therapy Alone for Recurrent or Metastatic Esophageal Cancer: A Systematic Review and Meta-Analysis
Presenter(s)
J. Wang, X. Lv, R. Zhang, W. Bai, Y. Cheng, and G. Gao; Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
Purpose/Objective(s): The role of radiotherapy (RT) in advanced esophageal cancer (EC) remains challenging and controversial. This study aims to perform a systematic review and comparative meta-analysis to evaluate the efficacy of RT combined with systemic therapy versus systemic therapy alone in metastatic or recurrent EC.
Materials/Methods: We systematically searched publications from PubMed, EMBASE, and Cochrane Library until January 21, 2025, without any language or article type restrictions. Outcomes included overall survival (OS) and progression-free survival (PFS). The study protocol was prospectively registered in PROSPERO (registration number CRD42024565583).
Results: A total of 12 studies comprising 18,060 patients were included, of which 11 were retrospective studies and 1 was a prospective non-randomized study. RT combined with systemic therapy was significantly associated with improved PFS (HR: 0.59, 95% CI: 0.48–0.73, P < 0.00001) and OS (HR: 0.72, 95% CI: 0.61–0.85, P < 0.0001). Subgroup analyses revealed enhanced clinical benefits in patients receiving RT doses =50 Gy (PFS: HR: 0.64, 95% CI: 0.56–0.73, P < 0.00001; OS: HR: 0.70, 95% CI: 0.63–0.78, P < 0.00001) or <50 Gy/unspecified doses (PFS: HR: 0.58, 95% CI: 0.40–0.85, P = 0.004; OS: HR: 0.80, 95% CI: 0.67–0.95, P = 0.01), pathological type of squamous cell carcinoma (PFS: HR: 0.69, 95% CI: 0.56–0.84, P = 0.0003; OS: HR: 0.65, 95% CI: 0.57–0.74, P < 0.00001) or no restrictions (PFS: HR: 0.47, 95% CI: 0.31–0.71, P = 0.0004; OS: HR: 0.80, 95% CI: 0.64–0.99, P = 0.04), metastatic status of oligometastasis (PFS: HR, 0.51, 95% CI, 0.39–0.66, P < 0.00001; OS: HR: 0.61, 95% CI: 0.49–0.77, P < 0.0001) or recurrence/metastasis (PFS: HR: 0.75, 95% CI: 0.59–0.95, P = 0.02; OS: HR: 0.80, 95% CI: 0.65–0.97, P = 0.03), and systemic treatment of chemotherapy (PFS: HR: 0.50, 95% CI: 0.37–0.67, P < 0.00001; OS: HR: 0.74, 95% CI: 0.61–0.90, P = 0.002) or immunotherapy/chemoimmunotherapy (PFS: HR: 0.73, 95% CI: 0.57–0.92, P = 0.008; OS: HR: 0.67, 95% CI: 0.52–0.86, P = 0.001). This result was also observed in patients who received RT for the primary tumor with or without metastasis (PFS: HR: 0.53, 95% CI: 0.42–0.67, P < 0.00001; OS: HR: 0.67, 95% CI: 0.54–0.82, P = 0.0001), but not in patients whose primary tumor radiation was unspecified (PFS: HR: 0.76, 95% CI: 0.54–1.05, P = 0.10; OS: HR: 0.87, 95% CI: 0.66–1.14, P = 0.30).
Conclusion: This meta-analysis indicates that RT combined with systemic therapy significantly prolongs PFS and OS in patients with metastatic or recurrent esophageal cancer. RT for the primary tumors could be a pivotal factor in improving survival.