3397 - Systemic Therapy with or without Local Radiotherapy for Advanced Esophageal Carcinoma: A Systematic Review and Meta-analysis
Presenter(s)
X. Chen, R. Cheng, C. Han, and L. Wang; Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
Purpose/Objective(s): The standard treatment for advanced esophageal cancer involves systemic drug therapy, but the prognosis remains poor. The role of radiotherapy in advanced esophageal cancer has yet to achieve consensus. This systematic review and meta-analysis was performed to compare the efficacy and safety of systemic drug therapy combined with local radiotherapy (Radiotherapy combined group, RT) versus systemic drug therapy alone (Non-radiotherapy combined group, NRT) in advanced esophageal cancer.
Materials/Methods: We comprehensively searched PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure (CNKI) from database inception to January 2024. This meta-analysis was performed to calculate the hazard ratio (HR) with 95% confidence interval (CI).
Results: A total of 11 studies were included, involving 2,178 patients, with squamous cell carcinoma accounting for 98.8%. The RT group demonstrated higher objective response rate (ORR) (OR=1.79, 95%CI: 1.42-2.27, P<0.001) and disease control rate (DCR) (OR=2.11, 95%CI: 1.58-2.82, P<0.001) compared to the NRT group. Radiotherapy significantly improved OS (HR=0.64, 95%CI: 0.58-0.71, P=0.001) and PFS (HR = 0.70, 95%CI: 0.63-0.78, P=0.001) compared with systemic drug therapy alone. Out of the 11 studies, 5 utilized chemotherapy or immunotherapy alone or in combination with radiotherapy as the observation group. Among these, 3 specifically focused on oligometastatic esophageal cancer and underwent stratified analysis. For patients who received immunotherapy, the OS (HR=0.62, 95%CI:0.45-0.85, P=0.003) and PFS (HR=0.58, 95%CI:0.45-0.75, P<0.001) of the RT group were significantly superior to those of the NRT group. Additionally, for patients with oligometastatic esophageal cancer, both OS (HR=0.73, 95%CI:0.64-0.84, P< 0.001) and PFS (HR=0.66, 95%CI:0.58-0.76, P<0.001) were notably better in the RT group compared to the NRT group. As for adverse events, the incidence of grade =3 hematological toxicity(OR=1.42, 95%CI:1.11-1.81, P=0.005) and treatment-related pneumonia(OR=3.29, 95%CI:1.43-7.56, P=0.005) was higher in the RT group than in the NRT group, while no significant difference was observed in gastrointestinal toxicity between these two groups (OR=0.96, 95%CI:0.66-1.39, P=0.83).
Conclusion: Compared to systemic therapy alone (chemotherapy/immunotherapy/chemoimmunotherapy), systemic therapy combined with radiotherapy can improve the short-term efficacy, OS, and PFS of advanced esophageal cancer. Combination therapy mainly increases the grade =3 hematological toxicity and treatment-related pneumonia, but they are controllable.