title: A Meta-Analysis of Concurrent Chemoradiotherapy for Advanced Esophageal Cancer.
abstract: BACKGROUND
  Concurrent chemoradiotherapy is a standard treatment for local advanced esophageal cancer, but the outcomes are controversial. Our goals were to compare the therapeutic effects of concurrent chemoradiotherapy and radiotherapy alone in local advanced esophageal cancer using meta-analysis.
  
  
  METHODS
  MEDLINE, EMBASE and the Cochrane library were searched for studies comparing chemoradiotherapy with radiotherapy alone for advanced esophageal cancer. Only randomized controlled trials were included, and extracted data were analyzed with Review Manager Version 5.2. The pooled relative risks (RR) and their 95% confidence intervals (CI) were calculated for statistical analysis.
  
  
  RESULTS
  Nine studies were included. Of 1,135 cases, 612 received concurrent chemoradiotherapy and 523 were treated with radiotherapy alone. The overall response rate (complete remission and partial remission) was 93.4% for concurrent chemoradiotherapy and 83.7% for radiotherapy alone (P = 0.05). The RR values of 1-year, 3-year, and 5-year survival rates were 1.14 (95% CI: 1.04 - 1.24, P = 0.006), 1.66 (95% CI: 1.34 - 2.06, P < 0.001), and 2.43 (95% CI: 1.63 - 3.63, P < 0.001), respectively. The RR value of the merged occurrence rate of acute toxic effects was 2.34 (95% CI: 1.90 - 2.90, P <0.001). There was no difference in the incidence of late toxic effects, which had an RR value of 1.21 (95% CI: 0.96 - 1.54, P = 0.11). The RR level of persistence and recurrence was 0.71 (95% CI: 0.62 - 0.81, P <0.001), and for the distant metastasis rate, the RR value was 0.79 (95% CI: 0.61 - 1.02, P = 0.07).
  
  
  CONCLUSIONS
  Concurrent chemoradiotherapy significantly improved overall survival rate, reduced the risk of persistence and recurrence, but had little effect on the primary tumor response, and increased the occurrence of acute toxic effects.
authors.affiliation: School of Nursing, Xinxiang Medical University, Henan, China.
authors.forename: Li-Li
authors.initials: LL
authors.lastname: Zhu
authors.affiliation: Department of Radiation, Henan Cancer Hospital, Zhengzhou, Henan, China; The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Yuan
authors.affiliation: Ontario Cancer Institute, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.affiliation: School of Nursing, Xinxiang Medical University, Henan, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Ye
authors.affiliation: School of Nursing, Xinxiang Medical University, Henan, China.
authors.forename: Gui-Ying
authors.initials: GY
authors.lastname: Yao
authors.affiliation: School of Nursing, Xinxiang Medical University, Henan, China.
authors.forename: Cui
authors.initials: C
authors.lastname: Liu
authors.affiliation: School of Nursing, Xinxiang Medical University, Henan, China.
authors.forename: Niu-Niu
authors.initials: NN
authors.lastname: Sun
authors.affiliation: School of Nursing, Xinxiang Medical University, Henan, China.
authors.forename: Xiao-Jing
authors.initials: XJ
authors.lastname: Li
authors.affiliation: Department of Oncology, The Third Affiliated Hospital, Xinxiang Medical University, Henan, China.
authors.forename: Shi-Cong
authors.initials: SC
authors.lastname: Zhai
authors.affiliation: School of Nursing, Xinxiang Medical University, Henan, China.
authors.forename: Ling-Juan
authors.initials: LJ
authors.lastname: Niu
authors.affiliation: School of Nursing, Xinxiang Medical University, Henan, China.
authors.forename: Jun-Bo
authors.initials: JB
authors.lastname: Zhang
authors.affiliation: Department of Molecular and Cellular Biology, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America.
authors.forename: Hong-Long
authors.initials: HL
authors.lastname: Ji
authors.affiliation: Center for Cancer Research, Xinxiang Medical University, Henan, China.
authors.forename: Xiu-Min
authors.initials: XM
authors.lastname: Li
mesh_terms: D059248:Chemoradiotherapy / Q000009:adverse effects; D016208:Databases, Factual; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D004941:Esophagitis / Q000209:etiology; D006801:Humans; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012074:Remission Induction; D015996:Survival Rate; D017211:Treatment Failure