title: Concurrent versus sequential chemoradiotherapy for esophageal cancer among Chinese population: a meta-analysis.
abstract: OBJECTIVE
  Esophageal cancer can cause substantial mortality and there is controversy about the effectiveness of concurrent and sequential chemoradiotherapy (CRT) for this disease.
  
  
  METHODS
  Based on established criteria, we searched electronic databases including PubMed, Excerpta Medica Database (Embase), China National Knowledge Infrastruction (CNKI), Wanfang, and Weipu databases up to March 2014 to collect eligible studies. Relative risks (RRs) and their 95% confidence intervals (CIs) were calculated. Q and I2 test were applied to test statistical heterogeneities among studies. Publication bias of total effective rate was evaluated through a funnel plot and sensitive analysis was conducted.
  
  
  RESULTS
  We identified 10 Chinese studies including 1024 esophageal cancer patients. The RRs of total effective rate and 1-, 2-, and 3-year survival rate for concurrent versus sequential CRT were 1.15 (95% CI 1.07 to 1.24), 1.15 (95% CI 1.05 to 1.26), 1.44 (95% CI 1.21 to 1.73), and 1.66 (95% CI 1.37 to 2.01), respectively, all with statistically significant differences (p&lt;0.05). With regards to incidence of leukocytopenia, the RR for concurrent versus sequential CRT was 1.14 (95% CI 1.03 to 1.26) with significant difference (p&lt;0.05). However, the RR of incidence of radiation esophagitis was 1.09 (95% CI 0.96 to 1.22) for concurrent versus sequential CRT without significant differences (p = 0.17).
  
  
  CONCLUSIONS
  Concurrent CRT was superior to sequential CRT for esophageal cancer management among Chinese people. Though higher toxic effects were revealed in concurrent CRT, it was tolerable. Therefore, concurrent CRT could be applied into esophageal cancer treatments for Chinese patients.
authors.affiliation: Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, Chengdu, Sichuan - China.
authors.forename: Fang
authors.initials: F
authors.lastname: Li
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.forename: Jiahua
authors.initials: J
authors.lastname: Lv
authors.forename: Yanqiong
authors.initials: Y
authors.lastname: Song
authors.forename: Churong
authors.initials: C
authors.lastname: Li
authors.forename: Peng
authors.initials: P
authors.lastname: Diao
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D044466:Asian People / Q000706:statistics & numerical data; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects* / Q000379:methods*; D002681:China / Q000453:epidemiology; D015986:Confounding Factors, Epidemiologic; D003627:Data Interpretation, Statistical; D016208:Databases, Factual; D004311:Double-Blind Method; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D004941:Esophagitis / Q000209:etiology; D004947:Esophagus / Q000187:drug effects / Q000528:radiation effects; D006801:Humans; D015994:Incidence; D007970:Leukopenia / Q000209:etiology; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards; D012107:Research Design / Q000592:standards; D016896:Treatment Outcome