Comparative effectiveness of image-guided radiotherapy for non-operated localized esophageal squamous cell carcinoma patients receiving concurrent chemoradiotherapy: A population-based propensity score matched analysis.
BACKGROUND
Although concurrent chemoradiotherapy (CCRT) coupled with image-guided radiotherapy (IGRT) is associated with a theoretical benefit in non-operated localized esophageal squamous cell carcinoma (NOL-ESCC) patients, there is currently no clinical evidence to support this.


RESULTS
The study population in the primary analysis comprised 866 patients who were well balanced in terms of their co-variables. The HR for mortality when group A was compared with group B was 0.82 (95% confidence interval, 0.7-0.95). SA revealed that the result was moderately sensitive.


METHODS
Eligible patients diagnosed between 2008 and 2013 were identified in the Taiwan Cancer Registry. A propensity score-matched cohort was constructed [1:1 in groups A (with IGRT) and B (without IGRT)] to balance any observable potential confounders. The hazard ratio (HR) for mortality was compared between groups A and B during the follow-up period. Sensitivity analyses (SA) were performed to evaluate the robustness of the findings regarding the selection of confounders and a potential unobserved confounder.


CONCLUSIONS
The current results provide the first clinical evidence that CCRT coupled with IGRT is associated with better overall survival when compared with CCRT without IGRT in NOL-ESCC patients. However, this study should be interpreted with caution given its non-randomized nature and the moderate sensitivity of the data. Further studies are needed to clarify this finding.
Cancer Center, Department of Radiation Oncology, China Medical University Hospital, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Chia-Chin
CC
Li
Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University, Chung Shan Medical University Hospital, Taichung, Taiwan.
Chih-Yi
CY
Chen
Cancer Center, Department of Radiation Oncology, China Medical University Hospital, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Chun-Ru
CR
Chien
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000628:therapy*; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D061089:Radiotherapy, Image-Guided / Q000379:methods*
concurrent chemoradiotherapy; esophageal squamous cell carcinoma; image-guided radiotherapy
J Thorac Dis. 2009 Dec;1(1):11-6
22262996
Radiat Oncol. 2013 Jun 07;8:137
23759081
J Radiat Res. 2010;51(4):355-64
20508375
J Natl Cancer Inst. 2009 Oct 21;101(20):1428; author reply 1429
19724025
J Thorac Dis. 2014 Dec;6(12):1690-6
25589961
J Cancer Res Clin Oncol. 2014 Sep;140(9):1595-605
24809934
Radiol Res Pract. 2014;2014:705604
25587445
Anticancer Res. 2014 Sep;34(9):5175-80
25202111
J Clin Oncol. 2005 Apr 1;23(10):2310-7
15800321
BMC Cancer. 2016 Feb 23;16:139
26906330
Oncotarget. 2015 Jan 30;6(3):1348-58
25593196
J Clin Oncol. 2007 Apr 1;25(10):1160-8
17401004
Thorac Cancer. 2014 Nov;5(6):530-6
26767048
Stat Med. 2014 Mar 30;33(7):1242-58
24122911
Stat Med. 2014 Jun 15;33(13):2297-340
24599889
Health Serv Res. 2014 Oct;49(5):1701-20
24779867
Thorac Cancer. 2016 Apr 26;7(3):288-95
27148413
Lancet. 2007 Oct 20;370(9596):1453-7
18064739
Cancer Control. 2013 Apr;20(2):97-110
23571700
J Thorac Dis. 2015 Sep;7(9):1643-9
26543613
Semin Radiat Oncol. 2012 Jan;22(1):50-61
22177878
Jpn J Clin Oncol. 2015 Mar;45(3):291-6
25601947
Dig Dis. 2013;31(1):30-7
23797120
J Clin Oncol. 2015 Jul 10;33(20):2231-8
25667281
Int J Radiat Oncol Biol Phys. 2014 Jun 1;89(2):370-5
24613810
Int J Radiat Oncol Biol Phys. 2014 Sep 1;90(1):11-24
25195986
Lancet. 2013 Feb 2;381(9864):400-12
23374478
Semin Radiat Oncol. 2014 Jan;24(1):25-34
24314339
J Gastrointest Surg. 2005 Jul-Aug;9(6):794-802
16187480