Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
Int J Radiat Oncol Biol Phys. 2023 Sep 1;117(1):31-44. doi: 10.1016/j.ijrobp.2023.05.025. Epub 2023 May 22.
Definitive chemoradiotherapy (dCRT) is a treatment option with curative intent for patients with esophageal cancer that could result in late toxicities and affect health-related quality of life (HRQoL). This study aimed to review the literature and perform a meta-analysis to investigate the effect of dCRT on late toxicities and HRQoL in esophageal cancer.
A systematic search was performed in MEDLINE, EMBASE, and PsychINFO. Prospective phase II and III clinical trials, population-based studies, and retrospective chart reviews investigating late toxicity or HRQoL after dCRT (≥50 Gy) were included. The HRQoL outcomes were analyzed using linear mixed-effect models with restricted cubic spline transformation. Any HRQoL changes of ≥10 points were considered clinically relevant. The risk of toxicities was calculated using the number of events and the total study population.
Among 41 included studies, 10 assessed HRQoL and 31 late toxicity. Global health status remained stable over time and improved after 36 months compared with baseline (mean change, +11). Several tumor-specific symptoms, including dysphagia, eating restrictions, and pain, improved after 6 months compared with baseline. Compared with baseline, dyspnea worsened after 6 months (mean change, +16 points). The risk of any late toxicity was 48% (95% CI, 33%-64%). Late toxicity risk of any grade for the esophagus was 17% (95% CI, 12%-21%), pulmonary 21% (95% CI, 11%-31%), cardiac 12% (95% CI, 6%-17%), and any other organ 24% (95% CI, 2%-45%).
Global health status remained stable over time, and tumor-specific symptoms improved within 6 months after dCRT compared with baseline, with the exception of dyspnea. In addition, substantial risks of late toxicity were observed.
确定性放化疗（dCRT）是一种有治愈意图的食管癌治疗选择，可能导致晚期毒性并影响健康相关生活质量（HRQoL）。本研究旨在综述文献并进行荟萃分析，以调查 dCRT 对食管癌晚期毒性和 HRQoL 的影响。
在 MEDLINE、EMBASE 和 PsychINFO 中进行系统检索。纳入前瞻性 II 期和 III 期临床试验、基于人群的研究和回顾性图表审查，以调查 dCRT（≥50Gy）后晚期毒性或 HRQoL。使用受限三次样条转换的线性混合效应模型分析 HRQoL 结果。任何 HRQoL 变化≥10 分被认为具有临床意义。使用事件数量和总研究人群计算毒性风险。
在 41 项纳入的研究中，有 10 项评估了 HRQoL，31 项评估了晚期毒性。与基线相比，全球健康状况随时间保持稳定，并在 36 个月后改善（平均变化，+11）。几种肿瘤特异性症状，包括吞咽困难、饮食限制和疼痛，在 6 个月后与基线相比得到改善。与基线相比，6 个月后呼吸困难恶化（平均变化，+16 分）。任何晚期毒性的风险为 48%（95%CI，33%-64%）。食管任何等级晚期毒性的风险为 17%（95%CI，12%-21%），肺为 21%（95%CI，11%-31%），心脏为 12%（95%CI，6%-17%），任何其他器官为 24%（95%CI，2%-45%）。
全球健康状况随时间保持稳定，与基线相比，肿瘤特异性症状在 dCRT 后 6 个月内得到改善，除了呼吸困难。此外，还观察到晚期毒性的高风险。
