title: Does higher radiation dose lead to better outcome for non-operated localized esophageal squamous cell carcinoma patients who received concurrent chemoradiotherapy? A population based propensity-score matched analysis.
abstract: The optimal radiotherapy dose for non-operated localized esophageal squamous cell carcinoma (NOL-ESCC) patients undergoing concurrent chemoradiotherapy (CCRT) is hotly debated.
  
  
  
  We identified eligible patients diagnosed within 2008-2013 from Taiwan Cancer Registry and constructed a propensity score matched cohort (1:1 for high dose (⩾60Gy) vs standard dose (50-50.4Gy)) to balance observable potential confounders. We compared the hazard ratio (HR) of death between standard and high radiotherapy dose groups during the entire follow-up period. We performed sensitivity analysis (SA) to evaluate the robustness of our finding regarding potential unobserved confounders & index date definition.
  
  
  
  Our study population constituted 648 patients with well balance in observed co-variables. The HR of death when high dose was compared to standard dose was 0.75 (95% confidence interval 0.64-0.88). Our result was sensitive to potential unobserved confounders but robust to alternative index date definition in SA.
  
  
  
  We found that higher than standard radiotherapy dose may lead to better survival for NOL-ESCC patients undergoing CCRT.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University, Chung Shan Medical University Hospital, Taiwan.
authors.forename: Chih-Yi
authors.initials: CY
authors.lastname: Chen
authors.affiliation: Cancer Center, China Medical University Hospital, Taiwan.
authors.forename: Chia-Chin
authors.initials: CC
authors.lastname: Li
authors.affiliation: Cancer Center, Department of Radiation Oncology, China Medical University Hospital; School of Medicine, College of Medicine, China Medical University, Taiwan. Electronic address: d16181@gmail.com.
authors.forename: Chun-Ru
authors.initials: CR
authors.lastname: Chien
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000628:therapy*; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000628:therapy*; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011879:Radiotherapy Dosage
keywords: Concurrent chemoradiotherapy; Esophageal squamous cell carcinoma; Radiotherapy dose