[an error occurred while processing this directive] | [an error occurred while processing this directive]
Efficacy of concurrent chemoradiotherapy with S‐1 vs. radiotherapy alone for elderly patients with esophageal cancer: a meta‐analysis
Yang Jianquan1,2, Guo Wen3, Lang Jinyi1,4, Lu Man1,2
1School of Medicine, University of Electronic Science and Technology of China, Chengdu 610054, China; 2Department of Ultrasound, Sichuan Cancer Hospital, University of Electronic Science and Technology of China, Chengdu 610041, China; 3School of Pharmacy, North Sichuan Medical University, Nanchong 637000, China; 4Department of Radiotherapy, Sichuan Cancer Hospital, University of Electronic Science and Technology of China, Chengdu 610041, China
AbstractObjective To evaluate the efficacy of concurrent radiotherapy combined with S‐1 (CCRT) versus radiotherapy (RT) alone in elderly patients with esophageal cancer by Meta‐analysis. Methods The Cochrane Library, PubMed, Web of science, EMbase, CBM, CNKI, VIP and Wanfang database were searched. The eligible studies were subject to evaluation of methodological quality. The Meta‐analysis was performed by the Revman 5.3 software. Results A total of 1693 patients were enrolled in 23 studies. The results showed that CCRT increased the incidence of CR [OR=2.08,95%CI (1.66‐2.61), P<0.001] and PR [OR=1.31,95%CI (1.08‐1.60), P=0.007] and total response rate [OR=2.99,95%CI (2.37‐3.77), P<0.001]. Furthermore, CCRT improved the 1‐year survival rate [OR=2.56, 95%CI (1.94‐3.38), P<0.001] and 2‐year survival rate [OR=2.33, 95%CI (1.77‐3.08), P<0.001]. Meanwhile, CCRT reduced the incidence of leucopenia, thrombocytopenia, radioactive esophagitis, nausea and vomiting (all P<0.05), but there was no significant difference in the incidence of anemia and radiation pneumonia between two groups (both P>0.05). Conclusions Available evidence suggests that CCRT combined with S‐1 can improve therapeutic efficacy and prolong survival time in elderly patients with esophageal cancer, but CCRT may increase the incidence of treatment‐related side effects. Due to the limitations of the number and quality of the included studies, the above conclusions need to be verified by more high‐quality studies.
Corresponding Authors:
Corresponding authors: Lang Jinyi, Email: langyj60@163.com; Lu Man, Email: graceof@163.com
Cite this article:
Yang Jianquan,Guo Wen,Lang Jinyi et al. Efficacy of concurrent chemoradiotherapy with S‐1 vs. radiotherapy alone for elderly patients with esophageal cancer: a meta‐analysis[J]. Chinese Journal of Radiation Oncology, 2022, 31(9): 791-797.
Yang Jianquan,Guo Wen,Lang Jinyi et al. Efficacy of concurrent chemoradiotherapy with S‐1 vs. radiotherapy alone for elderly patients with esophageal cancer: a meta‐analysis[J]. Chinese Journal of Radiation Oncology, 2022, 31(9): 791-797.
[1] Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209‐249. DOI: 10.3322/caac.21660. [2] 周家琛, 郑荣寿, 张思维, 等. 2000‐2015年中国肿瘤登记地区食管癌发病及年龄变化趋势[J]. 中华肿瘤防治杂志, 2020, 27(18): 1437‐1442. DOI: 10.16073/j.cnki.cjcpt.2020.18.01. Zhou JC, Zheng RS, Zhang SW, et al. Analysis on the trend of esophageal cancer incidence and age change in cancer registration areas of China,2000 to 2015[J].Chin J Cancer Prevent Treat,2020,27(18):1437‐1442. DOI: 10.16073/j.cnki.cjcpt.2020.18.01. [3] van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer[J]. N Engl J Med, 2012, 366(22):2074‐2084. DOI: 10.1056/NEJMoa1112088. [4] Chen Y, Ye J, Zhu Z, et al. Comparing paclitaxel plus fluorouracil versus cisplatin plus fluorouracil in chemoradiotherapy for locally advanced esophageal squamous cell cancer: A randomized, multicenter, phase III clinical trial[J]. J Clin Oncol, 2019, 37(20):1695‐1703. DOI: 10.1200/JCO.18.02122. [5] Koëter M, van Putten M, Verhoeven R, et al. Definitive chemoradiation or surgery in elderly patients with potentially curable esophageal cancer in the Netherlands: a nationwide population‐based study on patterns of care and survival[J]. Acta Oncol, 2018, 57(9):1192‐1200. DOI: 10.1080/0284186X.2018.1450521. [6] Vlacich G, Samson PP, Perkins SM, et al. Treatment utilization and outcomes in elderly patients with locally advanced esophageal carcinoma: a review of the national cancer database[J]. Cancer Med, 2017, 6(12):2886‐2896. DOI: 10.1002/cam4.1250. [7] Ji Y, Du X, Zhu W, et al. Efficacy of concurrent chemoradiotherapy with s‐1 vs radiotherapy alone for older patients with esophageal cancer: a multicenter randomized phase 3 clinical trial[J]. JAMA Oncol, 2021, 7(10):1459‐1466. DOI: 10.1001/jamaoncol.2021.2705. [8] Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?[J]. Control Clin Trials, 1996, 17(1):1‐12. DOI: 10.1016/0197‐2456(95)00134‐4. [9] 高颖, 吴艺君, 曾蕊, 等. 羊膜在小梁切除术中应用的Meta分析[J]. 中华实验眼科杂志, 2013, 31(3): 275‐281. DOI: 10.3760/cma.j.issn.2095‐0160.2013.03.017. Gao Y, Wu YJ, Zeng R, et al. A Meta‐analysis of operative effectiveness of trabeculectomy combined with amniotic membrane implant for glaucoma[J].Chin J Exp Ophthalmol,2013,31(3):275‐281. DOI: 10.3760/cma.j.issn.2095‐0160.2013.03.017. [10] 周燕, 汪庚明, 何泽来, 等. 替吉奥同步化疗联合放疗治疗老年食管癌的临床疗效分析[J]. 蚌埠医学院学报, 2020, 45(7): 871‐875. DOI: 10.13898/j.cnki.issn.1000‐2020.07.008. Zhou Y, Wang GM, He ZL, et al. Clinical effect analysis of tegafur/gimeracil/oteracil concurrent chemotherapy combined with radiotherapy in the treatment of esophageal cancer in elderly patient[J]. J Bengbu Med College,2020,45(7):871‐875. DOI: 10.13898/j.cnki.issn.1000‐2020.07.008. [11] 黄毅超, 刘云军, 张卓云, 等. 放疗联合替吉奥与单纯放疗治疗老年食管癌患者的效果比较[J]. 癌症进展, 2019, 17(14): 1664‐1666. DOI: 10.11877/j.issn.1672‐1535.2019.17.14.13. Huang YC, Liu YJ, Zhang ZY, et al. Comparison of the efficacy of radiotherapy combined with tigio and radiotherapy alone for elderly patients with esophageal cancer[J].Oncol Progress,2019,17(14):1664‐1666. DOI: 10.11877/j.issn.1672‐1535.2019.17.14.13. [12] 许涛, 景红霞, 曹风军, 等. 调强放疗联合替吉奥同步治疗非手术老年食管癌的临床疗效[J]. 中国老年学杂志, 2018, 38(5): 1090‐1093. DOI: 10.3969/j.issn.1005‐9202.2018.05.025. Xu T, Jing HX, Cao FJ, et al. Clinical efficacy of intensity modulated radiotherapy combined with tigio in the treatment of elderly patients with nonoperative esophageal carcinoma [J]. Chin J Gerontol,2018,38(5):1090‐1093. DOI: 10.3969/j.issn.1005‐9202.2018.05.025. [13] 崔力, 王伟明, 鲁光平. 替吉奥胶囊口服同步三维适形放疗治疗老年食管癌近期疗效观察[J]. 现代肿瘤医学, 2018, 26(20): 3242‐3245. DOI: 10.3969/j.issn.1672‐4992.2018.20.017. Cui L, Wang WM, Lu GP. Therapeutic efficacy of S‐1 combined with three‐dimensional conformal radiotherapy in elderly esophageal cancer patients[J].J Modern Oncol,2018,26(20):3242‐3245. DOI: 10.3969/j.issn.1672‐4992.2018.20.017. [14] 苗慧, 刘亚洲, 邵卫仙, 等. 累及野放疗联合替吉奥治疗非手术老年食管癌的近期疗效观察[J]. 徐州医科大学学报, 2017, 37(11): 738‐742. DOI: 10.3969/j.issn.1000‐2065.2017.11.010. Miao H, Liu YZ, Shao WX, et al. Observation on the short‐term effects of intensity‐modulated radiation therapy combined with tegafur in the treatment of elderly patients with esophageal carcinoma[J].Acta Academiae Medicinae Xuzhou,2017,37(11):738‐742. DOI: 10.3969/j.issn.1000‐2065.2017.11.010. [15] 刘俊才, 吴大鹏, 张洪志, 等. 三维适形放疗联合替吉奥同步化疗治疗老年食管癌疗效观察[J]. 山东医药, 2016, 56(3): 70‐71. DOI: 10.3969/j.issn.1002‐266X.2016.03.028. Liu JC, Wu DP, Zhang HZ, et al. Clinical observation of three‐dimensional conformal radiotherapy combined with simultaneous chemotherapy for treatment of senile esophageal carcinoma [J].Shandong Med J, 2016,56(3):70‐71. DOI: 10.3969/j.issn.1002‐266X.2016.03.028. [16] 龙翔宇, 周伟, 王兴远, 等. 替吉奥联合放疗治疗老年局部晚期食管癌疗效观察[J]. 昆明医科大学学报, 2015, 36(4): 121‐124. DOI: 10.3969/j.issn.1003‐4706.2015.04.032. Long Xu, Zhou W, Wang XY, et al. Evaluation of chemoradiotherapy with S‐1 for elder patients with local advanced esophageal cancer[J].J Kunming Med Univers,2015,36(4):121‐124. DOI: 10.3969/j.issn.1003‐4706.2015.04.032. [17] 张伟, 管峦, 殷海涛, 等. 替吉奥联合放疗治疗老年食管癌46例疗效观察[J]. 海南医学, 2015, 26(20): 3049‐3050. DOI: 10.3969/j.issn.1003‐6350.2015.20.1107. Zhang W, Guan L, Yin HT, et al. Clinical observation of 46 elderly patients with esophageal carcinoma treated with tigio combined with radiotherapy[J]. Hainan med, 2015,26(20):3049‐3050. DOI:10.3969/j.issn.1003‐6350.2015.20.1107. [18] 杭达明, 黄灿红, 万志龙, 等. 替吉奥同期放射治疗局部晚期老年人食管癌的临床观察[J]. 肿瘤研究与临床, 2015, 27(4): 256‐259. DOI: 10.3760/cma.j.issn.1006‐9801.2015.04.010. Hang DM, Huang CH, Wan ZL, et al.Clinical observation of concurrent radiotherapy combined with S‐1 for elderly patients with locally advanced esophageal cancer[J].Cancer Research and Clinic,2015,27(4):256‐259. DOI: 10.3760/cma.j.issn.1006‐9801.2015.04.010. [19] 卢文菁,赵波,张金梅.小剂量替吉奥联合三维适形放疗治疗老年食管癌的研究[J].现代中西医结合杂志,2015,24(03):260‐262. DOI: 10.3969/j. issn. 1008‐8849.2015.03.012. Lu WJ, Zhao B, Zhang JM. Study on the treatment of senile esophageal carcinoma with low dose of S‐1 combined with three‐dimensional conformal radiotherapy[J]. Chin J Modern Integrat Tradit Western Med, 2015,24(03):260‐262. DOI: 10.3969/j. issn. 1008‐8849.2015.03.012. [20] 陈大朝, 庄建发, 魏天安. 调强放疗联合替吉奥治疗未手术老年食管癌的近期疗效[J]. 实用癌症杂志, 2014, (8): 963‐965. DOI: 10.3969/j.issn.1001‐5930.2014.08.024. Chen DC, Zhuang JF, Wei TA. The short‐term effect of IMRT combined with tegafur gimeracil oteracil potassium for non‐surgical elderly patients with esophageal cancer[J]. Pract J Cancer,2014,(8):963‐965. DOI: 10.3969/j.issn.1001‐5930.2014.08.024. [21] 刘小群, 乔田奎. 三维适形放疗同步替吉奥治疗老年局部晚期食管癌效果观察[J]. 中国综合临床, 2014, (z1): 23‐25. DOI: 10.3760/cma.j.issn.1008‐6315.2014.z1.009. Liu XQ, Qiao TK. Efficacy of three‐dimensional conformal radiotherapy combined with concurrent S‐1 for locally advanced esophagus carcinoma in the elderly[J].Clin Med China,2014,(z1):23‐25. DOI: 10.3760/cma.j.issn.1008‐6315.2014.z1.009. [22] 宋利强, 盖娟娟. 替吉奥联合三维适形放疗治疗老年人食管癌临床观察[J]. 中国基层医药, 2014, 21(2): 179‐181. DOI: 10.3760/cma.j.issn.1008‐6706.2014.02.009. Song LQ, Gai JJ. Clinical observation of three‐dimensional conformal radiotherapy combined with S‐1 for elderly patients with esophageal cancer[J].Chin J Prim Med Pharm,2014,21(2):179‐181. DOI: 10.3760/cma.j.issn.1008‐6706.2014.02.009. [23] 宋婷婷, 卢琳, 鞠芳. 替吉奥联合同步放疗治疗老年局部晚期食管癌的临床观察[J]. 中国临床研究, 2014, 27(10): 1222‐1223. DOI: 10.13429/j.cnki.cjcr.2014.10.022 Song TT, Lu L, Ju F. For joint gonow synchronous radiation therapy for the treatment of senile locally advanced esophageal cancer clinical observation [J]. J Chin Clin Res, 2014, 27 (10): 1222‐1223. DOI: 10.13429/j.carol carroll nki CJCR. 2014.10.022. [24] 吕淑林, 马晓霞, 杭达明. 替吉奥同期化放疗治疗局部晚期食管癌老年患者的疗效观察及护理[J]. 世界临床药物, 2014, 35(9): 538‐541,569. DOI: 10.13429 /j. carol carroll nki CJCR. 2014.5.022. Lyu SL, Ma XX, Hang DM. Clinical effect observation and nursing of concurrent chemoradiotherapy combined with oteracil potassium capsule for elderly patients with locally advanced esophageal cancer[J].World Clin Drugs,2014,35(9):538‐541,569. DOI: 10.13429 /j. carol carroll nki CJCR. 2014.5.022. [25] 王向前, 蔡晶, 顾红芳, 等. 放疗同步联合替吉奥治疗老年食管癌的临床观察[J]. 临床肿瘤学杂志, 2013, 18(5): 434‐437. DOI: 10.3969/j.issn.1009‐0460.2013.05.012. Wang XQ, Cai J, Gu HF, et al. Clinical observation of simultaneous radiotherapy combined with gio in elderly patients with esophageal carcinoma [J]. J Clin Oncol, 2013,18(05):434‐437. DOI: 10.3969/j. issn. 1009‐0460.2013.05.012. [26] 张信强, 徐燕, 陈明祥. 三维适形放疗联合替吉奥同步化疗治疗老年食管癌疗效观察[J]. 现代中西医结合杂志, 2013, 22(21): 2322‐2323. DOI: 10.3969/j.issn.1008‐8849.2013.21.019. Zhang XQ, Xu Y, Chen MX. Clinical observation of three‐dimensional conformal radiotherapy combined with simultaneous chemotherapy for treatment of senile esophageal carcinoma [J]. J Modern Integrat Chin Western Med, 2013,22(21):2322‐2323. DOI: 10.3969/j. issn. 1008‐8849.2013.21.019. [27] 王光明. 替吉奥联合三维适形同期放疗治疗老年食管癌的临床观察[J]. 安徽医学, 2013, 34(7): 920‐922. DOI: 10.3969/j.issn.1000‐0399.2013.07.021. Wang GM. Clinical observation of S‐1 combined with three‐dimensional conformal radiotherapy in the treatment of elderly patients with esophageal carcinoma during the same period[J].Anhui Med J,2013,34(7):920‐922. DOI: 10.3969/j.issn.1000‐0399.2013.07.021. [28] 刘小平, 施璠, 刘锐. 三维适形放疗联合替吉奥治疗老年食管癌患者的临床研究[J]. 现代肿瘤医学, 2013, 21(12): 2721‐2722. DOI: 10.3969/j.issn.1672‐4992.2013.12.25. Liu XP, Shi F, Liu R. Clinical study of S‐1 combined with three‐dimensional conformal radiotherapy for elderly patients with esophageal cancer[J].J Modern Oncol,2013,21(12):2721‐2722. DOI: 10.3969/j.issn.1672‐4992.2013.12.25. [29] 蒋晓东, 戴鹏, 吴瑾, 等. 替吉奥联合调强放疗治疗老年食管癌的临床研究[J]. 中国医院药学杂志, 2012, 32(2): 130‐133. DOI: 10.3969/j.issn.1672‐4992.2013.7.25. Jiang XD, Dai P, Wu J, et al. TS‐1 combined with intensity modulated radiation therapy(IMRT) for elder patients with esophageal cancer[J].Chin J Hospit Pharm,2012,32(2):130‐133. DOI: 10.3969/j.issn.1672‐4992.2013.7.25. [30] 张永喜, 刘淑媛, 李君艳, 等. 老年食管癌替吉奥同期放疗的临床疗效观察[J]. 中华肿瘤防治杂志, 2012, 19(9): 686‐688. DOI: 10.3969/j.issn.1672‐4992.2013.4.25. Zhang YX, Liu SY, Li JY, et al. Efficacy of gimeracil and oteracil porassium capsules on the treatment of elderly esophageal cancer with concomitant radiation therapy[J]. Chin J Cancer Prev Treat,2012,19(9):686‐688. DOI: 10.3969/j.issn.1672‐4992.2013.4.25. [31] 中国医师协会放射肿瘤治疗医师分会, 中华医学会放射肿瘤治疗学分会, 中国抗癌协会肿瘤放射治疗专业委员会. 中国食管癌放射治疗指南(2020年版)[J]. 国际肿瘤学杂志, 2020, 47(11): 641‐655. DOI: 10.3760/cma.j.cn371439‐20201015‐00095 Radiation Tumor Therapy Branch of Chinese Medical Association, Radiation Tumor Therapy Branch of Chinese Medical Association, Tumor Radiation Therapy Professional Committee of Chinese Anti‐Cancer Association. Chinese guidelines for radiotherapy of esophageal cancer (2020 edition)[J]. J Int Oncol, 2020,47:641‐655. DOI: 10.3760/cma.j.cn371439‐20201015‐00095. [32] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6):394‐424. DOI: 10.3322/caac.21492. [33] 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. Esophageal cancer diagnosis and treatment standards (2018 edition)[J]. Chin Digest Dis Video Magazine (elect vers), 2019, 9 (4): 158‐192. DOI:10.3877/cma.J.iSSN.2095‐2015.2019.04.005. [34] Chen Y, Ye J, Zhu Z, et al. Comparing paclitaxel plus fluorouracil versus cisplatin plus fluorouracil in chemoradiotherapy for locally advanced esophageal squamous cell cancer: A randomized, multicenter, phase III clinical trial[J]. J Clin Oncol, 2019, 37(20):1695‐1703. DOI: 10.1200/JCO.18.02122. [35] Xu C, Xi M, Moreno A, et al. Definitive chemoradiation therapy for esophageal cancer in the elderly: clinical outcomes for patients exceeding 80 years old[J]. Int J Radiat Oncol Biol Phys, 2017, 98(4):811‐819. DOI: 10.1016/j.ijrobp.2017.02.097. [36] 谢博文, 臧潞, 马君俊, 等. 奥沙利铂联合卡培他滨或联合替吉奥新辅助化疗方案在进展期胃癌治疗中的安全性和有效性[J]. 中华胃肠外科杂志, 2021, 24(2): 138‐144. DOI: 10.3760/cma.j.cn.441530‐20200721‐00433. Xie BW, Zang L, Ma JJ, et al. Safety and effectiveness of oxaliplatin combined with capecitabine or oxaliplatin combined with S‐1 neoadjuvant chemotherapy in the treatment of advanced gastric cancer[J].Chin J Gastrointest Surg,2021,24(2):138‐144. DOI: 10.3760/cma.j.cn.441530‐20200721‐00433. [37] 于佳琦, 张臻, 任凯, 等. 利用放射组学模型预测肺癌和食管癌患者发生放射性肺炎的研究[J]. 中华放射肿瘤学杂志, 2021, 30(11): 1111‐1116. DOI: 10.3760/cma.j.cn113030‐20210119‐00032. Yu JQ, Zhang Z, Ren K, et al. Study of application of radiomics model in predicting radiation pneumontis in patients with lung cancer and esophageal cancer[J].Chin J Radiat Oncol,2021,30(11):1111‐1116. DOI: 10.3760/cma.j.cn113030‐20210119‐00032. [38] 杜峰, 王强, 王玮, 等. CBCT影像组学联合构建nomogram模型预测食管癌放疗患者放射性肺炎[J]. 中华放射肿瘤学杂志, 2021, (6): DOI: 10.3760/cma.j.cn113030‐20200703‐00339. Du F, Wang Q, Wang W, et al. A nomogram model based on cone beam CT radiomics combined with clinical features and dosimetric parameters predicting radiation pneumonitis in patients with esophageal cancer receiving radiotherapy[J].Chin J Radiat Oncol,2021,(6)DOI: 10.3760/cma.j.cn113030‐20200703‐00339.
2022, Vol. 31 
