Abstract：Objective To compare the efficacy and adverse events of salvage radiotherapy and other treatments for recurrent esophageal cancer after chemoradiotherapy in this Meta-analysis. Methods Databases including PubMed, Embase, Cochrane Library, CNKI and Wanfang data were searched from the inception to April 2020 to collect the clinical trials which comparatively analyzed the efficacy and safety between radiotherapy and other treatments for recurrent esophageal cancer after chemoradiotherapy. Meta-analysis was performed using RevMan 5.1 software. RR and 95%CI were used to describe the differences among different groups. Results According to the inclusion and exclusion criteria, a total of 11 clinical trials involving 842 patients were included. Meta-analysis showed that the overall survival in the salvage radiotherapy group was significantly lower than that in the salvage esophagectomy group (RR=0.40,95%CI:0.27-0.61,P<0.001), whereas significantly higher than that in the chemotherapy group (RR=2.91,95%CI:1.43-5.95,P=0.003). There was no significant difference in the treatment-related mortality between the salvage radiotherapy and salvage esophagectomy groups (RR=0.53,95%CI:0.14-1.98,P=0.350), but the incidence was significantly higher in the salvage esophagectomy group (1.7%-11.4% vs. 1.9%-2.8%). Conclusion Salvage radiotherapy is an effective treatment for recurrent esophageal cancer after chemoradiotherapy, which can be regarded as one choice for clinical patients.
Yu Wenhui,Zhang Ping,Zhen Chanjun et al. Efficacy and safety of salvage radiotherapy for recurrent esophageal cancer after chemoradiotherapy:a Meta-analysis[J]. Chinese Journal of Radiation Oncology, 2021, 30(9): 892-897.
[1] Liang H, Fan JH, Qiao YL.Epidemiology, etiology, and prevention of esophageal squamous cell carcinoma in China[J]. Cancer Biol Med, 2017, 14(1):33-41.DOI:10.20892/j.issn.2095-3941.2016.0093. [2] 国家卫生健康委员会.食管癌诊疗规范(2018年版)[J]. 中华消化病与影像杂志(电子版),2019, 9(4):158-192.DOI:10.3877/cma.j.issn.2095-2015.2019.04.005. National Health Commission.Guidelines for the diagnosis and treatment of esophageal neoplasms (2018 edition)[J]. Chin J Digest Med Imageol (Elec Ed), 2019, 9(4):158-192.DOI:10.3877/cma.j.issn.2095-2015.2019.04.005. [3] Shioyama Y, Nakamura K, Ohga S, et al.Radiation therapy for recurrent esophageal cancer after surgery:Clinical results and prognostic factors[J]. Jpn J Clin Oncol, 2007, 37(12):918-923.DOI:10.1093/jjco/hym138. [4] Tachimori Y.Role of salvage esophagectomy after definitive chemoradiotherapy[J]. Gen Thorac Cardiovasc Surg, 2009, 57(2):71-78.DOI:10.1007/s11748-008-0337-5. [5] Yano M, Takachi K, Doki Y, et al.Prognosis of patients who develop cervical lymph node recurrence following curative resection for thoracic esophageal cancer[J]. Dis Esophagus, 2006, 19(2):73-77.DOI:10.1111/j.1442-2050.2006.00543.x. [6] Stang A.Critical evaluation of the newcastle-ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9):603-605.DOI:10.1007/s10654-010-9491-z. [7] 陈泽鑫,刘慧,潘益峰,等.试验性和观察性研究相关医学文献质量评价方法[J]. 中国循证医学杂志,2011,11(11):1229-1236.DOI:10.3969/j.issn.1672-2531.2011.11.002. Chen ZX, Liu H, Pan YF, et al.Methods of quality evaluation of medical literatures[J]. Chin J Evid Bas Med, 2011, 11(11):1229-1236.DOI:10.3969/j.issn.1672-2531.2011.11.002. [8] Higgins JP, Altman DG, Gøtzsche PC, et al.The cochrane collaboration's tool for assessing risk of bias in randomised trials[J]. BMJ, 2011, 343: d5928.DOI:10.1136/bmj.d5928. [9] 王山,史卫红,周鉴基.食管癌放疗后局部复发者施行手术切除的临床分析[J]. 中国医药指南,2015, 13(25):32-33.DOI:10.15912/j.cnki.gocm.2015.25.019. Wang S, Shi WH, Zhou JJ.Clinical analysis of esophageal cancer after radiotherapy surgery to remove the local recurrence[J]. Guide Chin Med, 2015, 13(25):32-33.DOI:10.15912/j.cnki.gocm.2015.25.019. [10] 叶宏勋,戴荣军,项其昌.食管癌放疗后复发再程治疗的疗效观察[J]. 河南肿瘤学杂志,2003, 16(6):420-421.DOI:10.3969/j.issn.1673-5412.2003.06.013. Ye HX, Dai RJ, Xiang QC.The observation of therapeutic effects of re-course therapy for recurrence from esophageal carcinoma after radiotherapy[J]. Henan J Oncol, 2003, 16(6):420-421.DOI:10.3969/j.issn.1673-5412.2003.06.013. [11] 袁小平,郭昭扬.食管癌根治性放疗后复发的再治疗问题的探讨[J]. 镇江医学院学报,2001, 11(3):384-385.DOI:10.3969/j.issn.1671-7783.2001.03.064. Yuan XP, Guo ZY.The discussion about retreatment in recurrent esophageal cancer after radical radiotherapy[J]. J Zhenjiang Med College, 2001, 11(3):384-385.DOI:10.3969/j.issn.1671-7783.2001.03.064. [12] 王鹤皋,张佩怀,李杰,等.根治性放疗后食管癌复发的手术切除和再程放疗的比较[J]. 中华放射肿瘤学杂志,1996, 5(1):4-6. Wang HG, Zhang PH, Li J, et al.Comparision between operation and secondary radiotherapy for recurrent esophageal carcinoma after radical radiotherapy[J]. Chin J Radiat Oncol, 1996, 5(1):4-6. [13] 赵常有.食管癌根治性放疗复发再程放疗的临床研究[J]. 现代诊断与治疗,2018, 29(24):3945-3947.DOI:10.3969/j.issn.1001-8174.2018.24.006. Zhao CY.Clinical study of radical radiotherapy for recurrent esophageal cancer[J]. Mod Diagn Treat, 2018, 29(24):3945-3947.DOI:10.3969/j.issn.1001-8174.2018.24.006. [14] 陈永顺,程欣宇,宋海侠,等.食管癌根治性放化疗后局部复发挽救治疗研究[J]. 中华放射肿瘤学杂志,2019, 28(11):826-829.DOI:10.3760/cma.j.issn.1004-4221.2019.11.006. Chen YS, Cheng XY, Song HX, et al.Clinical study of salvage strategy for patients with locally recurrent esophageal cancer after definitive radiochemotherapy[J]. Chin J Radiat Oncol, 2019, 28(11):826-829.DOI:10.3760/cma.j.issn.1004-4221.2019.11.006. [15] 吴迪.食管癌根治性放疗后局部区域失败再治疗模式的分析[D]. 石家庄:河北医科大学,2018.DOI:10.7666/d.D01514824. Wu D.The analysis of re-treatment pattern of local regional failure for esophageal carcinoma after definitive radiotherapy[D]. Shijiazhuang:Hebei Medical University, 2018.DOI:10.7666/d.D01514824. [16] Zhou ZG, Zhen CJ, Bai WW, et al.Salvage radiotherapy in patients with local recurrent esophageal cancer after radical radiochemotherapy[J]. Radiat Oncol, 2015, 10:54.DOI:10.1186/s13014-015-0358-z. [17] Chen Y, Lu Y, Wang Y, et al.Comparison of salvage chemoradiation versus salvage surgery for recurrent esophageal squamous cell carcinoma after definitive radiochemotherapy or radiotherapy alone[J]. Dis Esophagus, 2014, 27(2):134-140.DOI:10.1111/j.1442-2050.2012.01440.x. [18] 尤振兵,嵇建,徐达夫,等.根治性放疗后复发食管癌行手术和再放疗的回顾性研究[J]. 西部医学,2012, 24(2):343-345.DOI:10.3969/j.issn.1672-3511.2012.02.057. You ZB, Ji J, Xu DF, et al.Retrospective study the efficacy of the surgery or raditherapy again for recurrent patients with esophageal cancer after radical radiotherapy[J]. Med J West Chin, 2012, 24(2):343-345.DOI:10.3969/j.issn.1672-3511.2012.02.057. [19] 郝颖坤,赵瑞芬,王鹤皋,等.局部复发食管癌再放疗疗效观察(附 55例分析)[J]. 山西医药杂志,1992, 21(1):33. Hao YK, Zhao RF, Wang HG, et al.Observation on the efficacy of re-radiotherapy for locally recurrent esophageal carcinoma (analysis of 55 cases)[J]. Shanxi Med J, 1992, 21(1):33. [20] Ajani JA, D'Amico TA, Bentrem DJ, et al.Esophageal and esophagogastric junction cancers, version 2.2019, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2019, 17(7):855-883.DOI:10.6004/jnccn.2019.0033. [21] Nishimura M, Daiko H, Yoshida J, et al.Salvage esophagectomy following definitive chemoradiotherapy[J]. Gen Thorac Cardiovasc Surg, 2007, 55(11):461-464;discussion 464-465.DOI:10.1007/s11748-007-0157-z. [22] Chao YK, Chan SC, Chang HK, et al.Salvage surgery after failed chemoradiotherapy in squamous cell carcinoma of the esophagus[J]. Eur J Surg Oncol, 2009, 35(3):289-294.DOI:10.1016/j.ejso.2008.02.014. [23] Hong L, Huang YX, Zhuang QY, et al.Survival benefit of re-irradiation in esophageal cancer patients with locoregional recurrence:a propensity score-matched analysis[J]. Radiat Oncol, 2018, 13(1):171.DOI:10.1186/s13014-018-1122-y. [24] Kitagawa Y, Uno T, Oyama T, et al.Esophageal cancer practice guidelines 2017 edited by the Japan esophageal society:part 2[J]. Esophagus, 2019, 16(1):25-43.DOI:10.1007/s10388-018-0642-8. [25] Wong Hee Kam S, Rivera S, Hennequin C, et al.Salvage high-dose-rate brachytherapy for esophageal cancer in previously irradiated patients:a retrospective analysis[J]. Brachytherapy, 2015, 14(4):531-536.DOI:10.1016/j.brachy.2015.02.392. [26] Tachimori Y, Kanamori N, Uemura N, et al.Salvage esophagectomy after high-dose chemoradiotherapy for esophageal squamous cell carcinoma[J]. J Thorac Cardiovasc Surg, 2009, 137(1):49-54.DOI:10.1016/j.jtcvs.2008.05.016. [27] Yoo C, Park JH, Yoon DH, et al.Salvage esophagectomy for locoregional failure after chemoradiotherapy in patients with advanced esophageal cancer[J]. Ann Thorac Surg, 2012, 94(6):1862-1868.DOI:10.1016/j.athoracsur.2012.07.042. [28] Schieman C, Wigle DA, Deschamps C, et al.Salvage resections for recurrent or persistent cancer of the proximal esophagus after chemoradiotherapy[J]. Ann Thorac Surg, 2013, 95(2):459-463.DOI:10.1016/j.athoracsur.2012.10.028. [29] Fakhrian K, Gamisch N, Schuster T, et al.Salvage radiotherapy in patients with recurrent esophageal carcinoma[J]. Strahlenther Onkol, 2012, 188(2):136-142.DOI:10.1007/s00066-011-0023-x. [30] Kumagai K, Mariosa D, Tsai JA, et al.Systematic review and meta-analysis on the significance of salvage esophagectomy for persistent or recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy[J]. Dis Esophagus, 2016, 29(7):734-739.DOI:10.1111/dote.12399. [31] D'Journo XB, Michelet P, Dahan L, et al.Indications and outcome of salvage surgery for oesophageal cancer[J]. Eur J Cardiothorac Surg, 2008, 33(6):1117-1123.DOI:10.1016/j.ejcts.2008.01.056. [32] Chen HY, Ma XM, Ye M, et al.Esophageal perforation during or after conformal radiotherapy for esophageal carcinoma[J]. J Radiat Res, 2014, 55(5):940-947.DOI:10.1093/jrr/rru031. [33] Teli MA, Mushood GN, Zargar SA, et al.Comparative evaluation between re-irradiation and demand endoscopic dilatation vs. endoscopic dilatation alone in patients with recurrent/reactivated residual in-field esophageal malignancies[J]. J Cancer Res Ther, 2008, 4(3):121-125.DOI:10.4103/0973-1482.43140. [34] Wang J, Wei J, Xiang F, et al.Analysis of three-dimensional conformal radiotherapy for local recurrence of esophageal cancer after definitive radiotherapy[J]. Int J Oncol, 2017, 44(2):99-103.DOI:10.3760/cma.j.issn.1673-422X.2017.02.005.
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