Efficacy and safety of radiotherapy in first-line treatment for de novo advanced esophageal cancer in the era of immunochemotherapy: a systematic review and meta-analysis
A partir d'une revue systématique de la littérature publiée jusqu'au 1er février 2025 (8 études, 11 356 patients), cette méta-analyse évalue l'efficacité, du point de vue de la survie globale, et la sécurité d'une stratégie thérapeutique de première ligne combinant une radiothérapie et un traitement systémique (chimiothérapie ou immunothérapie) pour un cancer de l'oesophage de novo de stade avancé
Purpose: To evaluate the efficacy and safety of systemic treatment combined with radiotherapy (RT) as the first-line treatment for de novo advanced esophageal cancer (EC).
Methods: A meta-analysis was conducted, and it followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A literature search was performed systematically in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science on February 1, 2025. The protocol of this meta-analysis was published in PROSPERO with the registration number CRD42025650118.
Results: Eight studies involving a total of 11,356 patients were finally included. Systemic treatment combined with RT improved OS (HR = 0.72, 95% CI: 0.70–0.74, P < 0.001) and PFS (HR = 0.70, 95% CI: 0.62–0.78, P < 0.001) compared with systemic treatment alone. The grade ≥ 3 treatment-related lymphopenia (OR = 5.52, P < 0.001), leukopenia (OR = 1.56, P < 0.001), and esophagitis (OR = 13.11, P < 0.001) were more frequent in the RT-combined group; no significant differences were observed in other severe toxicities. Subgroup analysis on systemic treatment type, ESCC, and TNM stage edition also demonstrated that this RT-combined treatment could provide significant survival benefits. Exploratory analysis showed that maximal survival benefit emerged in patients who received systemic therapy, especially immunochemotherapy, combined with radical (≥ 50 Gy) primary tumor RT.
Conclusions: By synthesizing data from both the pre-immunotherapy and immunotherapy eras involving 11,356 patients, we found that the incorporation of radical radiotherapy into first-line systemic treatment regimens improves survival outcomes while maintaining acceptable toxicity profiles in selected patients with advanced EC.
BMC Cancer , article en libre accès, 2025