Accelerated or hyperfractionated radiotherapy for esophageal carcinoma: a meta-analysis of randomized controlled trials

Objective: The goal of this study was to evaluate the efficacy and safety of modified (accelerated and/or hyperfractionated) radiotherapy in the treatment of esophageal carcinoma, compared with conventional radiotherapy. Methods: Studies published in the PubMed, Cochrane Library, EMBASE, CBM, VIP, CNKI and Wanfang databases in the most recent two decades were searched for use in this meta-analysis. Only randomized controlled trials were included. The heterogeneity analysis and calculation of the pooled odds ratio (OR) were performed using RevMan 5.3 software. The assessment of publication bias and sensitivity analyses was conducted using Stata 13.0 software. Results: Twenty trials with a total of 1,742 Chinese patients who met the inclusion criteria were included. The pooled results showed that modified radiotherapy improved the response rate compared with conventional schedules (OR = 3.90, 95% confidence interval [CI]: 2.47-6.16, P, 0.001). Favorable results were observed for the 1-year (OR = 2.58, 95% CI: 2.05-3.26, P, 0.001), 3-year (OR = 2.30, 95% CI: 1.83-2.89, P, 0.001) and 5-year (OR = 2.36, 95% CI: 1.74-3.21, P, 0.001) overall survival and for the 1-year (OR = 2.46, 95% CI: 1.72-3.51, P, 0.001), 3-year (OR = 2.08, 95% CI: 1.49-2.90, P, 0.001) and 5-year (OR = 2.15, 95% CI: 1.38-3.34, P, 0.001) overall local control rate in the modified fractionation radiotherapy group. However, the altered radiotherapy increased the risk of acute radiation esophagitis (OR = 1.70, 95% CI: 1.27-2.28, P, 0.001) and acute radiation tracheitis (OR = 1.47, 95% CI: 1.09-1.99, P= 0.01). No significant differences in the risk of esophageal perforation (OR = 1.30, 95% CI: 0.51-3.32, P= 0.58) or esophagorrhagia (OR = 0.88, 95% CI: 0.41-1.88, P= 0.74) were found between the two groups. Conclusion: Chinese patients with squamous cell esophagus carcinomas gained a significant benefit in terms of the response rate, survival and local control rates from the modified fractionation radiotherapy, but also had an increased risk of acute radiation reactions. Otherwise, there was no observed statistically significant difference in terms of early adverse reactions.