Is there a role for neoadjuvant radiation dose escalation in esophageal cancer? A meta-analysis.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 102-102
Author(s):  
Laila Lobo ◽  
Danny Yakoub ◽  
Caroline Ripat ◽  
Rishika Sharma ◽  
Raphael Yechieli
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Radiation Dose ◽  
Esophageal Carcinoma ◽  
Meta Analysis ◽  
Survival Rates ◽  
Fistula Formation ◽  
Significant Difference ◽  
Patient Reported

102 Background: In treating esophageal cancer chemo-radiation is used in the definitive as well as neo-adjuvant setting. Optimal dosage of radiation for best outcome has been debated. The aim of this study is to evaluate clinical outcomes of lower radiation dosage compared to higher. Methods: Online search for studies comparing radiation dose from 1990 to present was performed. Primary outcome was overall-survival rates for up to 5 years. Secondary outcomes included post-treatment complications and treatment response. A cut point of 51 Gy and less was considered as lower dose and greater than 51 Gy was considered higher dose. Quality of included studies was evaluated by STROBE criteria. Relative Risk (RR) and 95% Confidence Intervals (CI) were calculated from pooled data. Results: The search strategy yielded 142 studies, 12 met our selection criteria and included 1876 patients receiving radiation for resectable esophageal carcinoma. Of these patients, 1057 received lower and 819 were treated with greater than 51 Gy. Median age was 63 and 64 years for lower and higher radiation dose respectively. Meta-analysis showed no statistically significant difference in survival and toxicities between the two groups. 1 year overall survival (RR = 0.97, 95% CI 0.84-1.13, p = 0.69), 2 year overall survival (RR = 1.29, 95% CI 0.76-2.19, p = 0.34), 3 year overall survival (RR = 1.18, 95% CI 0.83-1.68, p = 0.37), 4 year overall survival (RR = 1.37, 95% CI 0.64-2.94, p = 0.41), 5 year overall survival (RR = 1.11, 95% CI 0.72-1.69, p = 0.64), Esophagitis (RR = 0.76, 95% CI 0.39-1.50, p = 0.43), Dermatitis (RR = 0.98, 95% CI 0.12-7.94, p = 0.99), Fistula formation (RR = 0.72, 95% CI 0.32-1.60, p = 0.42), Hematologic complications (RR = 1.10, 95% CI 0.20-6.02, p = 0.91), Stricture formation (RR = 1.39, 95% CI 0.54-3.58, p = 0.5). Conclusions: Lower radiation dose appears to be as effective as higher dose in esophageal carcinoma with similar toxicity profile and survival rates. Larger prospective randomized trials, focusing on patient-reported quality-of-life are required to consolidate these results.

Unresectable hepatocellular carcinoma: Is radio-embolization an alternative for chemo-embolization?

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 323-323
Author(s):  
Laila Lobo ◽  
Danny Yakoub ◽  
Omar Picado ◽  
Caroline Ripat ◽  
Fiorella Pendola ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Meta Analysis ◽  
Survival Rates ◽  
Complete Response ◽  
Post Treatment ◽  
Safe Alternative ◽  
Unresectable Hepatocellular Carcinoma ◽  
Significant Difference ◽  
Patient Reported

323 Background: Transarterial Radio-embolization (TARE) has emerged as a newer regional technique to Transarterial Chemo-embolization (TACE) for treatment of unresectable hepatocellular carcinoma (HCC). The aim of this study is to evaluate clinical outcomes of both techniques. Methods: Online search for studies comparing TARE to TACE from 2005 to present was performed. Primary outcome was overall survival rate for up to 4 years. Secondary outcomes included post-treatment complications and treatment response. Quality of included studies was evaluated by STROBE criteria. Relative Risk (RR) and 95% Confidence Intervals (CI) were calculated from pooled data. Results: The search strategy yielded 172 studies, 5 met our selection criteria and included 653 patients undergoing embolization for unresectable HCC. Of these patients, 284 underwent TACE and 269 underwent TARE. Median age was 63 and 64 years for TACE and TARE, respectively. Meta-analysis showed no statistically significant difference in survival for up to 4 years between the two groups (HR = 1.06; 95% CI: 0.81-1.46, p = 0.567). TACE required at least one day of hospital stay compared to TARE which was mostly an outpatient procedure. TACE had more post-treatment pain than TARE (RR = 1.96, 95% CI: 1.40-2.75, p < 0.01), but less subjective fatigue (RR = 0.62, 95% CI: 0.48-0.80, p < 0.01). There was no difference between the two groups in the incidence of post-treatment nausea, vomiting, fever or other complications. In addition, there was no difference in partial or complete response rates between the two groups. Conclusions: TARE appears to be a safe alternative treatment to TACE with similar complication profile and survival rates. Larger prospective randomized trials, focusing on patient-reported quality-of-life are required to consolidate these results, and to evaluate cost vs benefit for both techniques.

Patient-reported outcomes from a phase III multicenter, randomized, double-blind, placebo-controlled trial of gefitinib versus placebo in esophageal cancer progressing after chemotherapy: Cancer Oesophagus Gefitinib (COG).

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 6-6
Author(s):  
Susan J. Dutton ◽  
Jane M. Blazeby ◽  
Russell D. Petty ◽  
Wasat Mansoor ◽  
Joyce Thompson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Overall Survival ◽  
Esophageal Cancer ◽  
Patient Reported Outcomes ◽  
Predictive Biomarkers ◽  
Phase Iii ◽  
Patient Reported ◽  
Global Quality Of Life ◽  
Eortc Qlq

6 Background: There are no randomised trials of 2nd line chemotherapy for esophageal cancer. The phase III COG trial of gefitinib versus placebo in patients with esophageal cancer progressing after chemotherapy did not show significant overall survival (OS) benefit, however the trial incorporated patient reported outcomes (PRO) using validated tools. The PRO data are therefore critical to inform practice and the initial results are presented here. Methods: Adults with measurable/evaluable metastatic esophageal or types I/II junctional adeno or squamous cell carcinoma progressing after prior chemotherapy, with performance status 0-2 were randomised 1:1 to 500mg gefitinib (G) or placebo (P), treated until progression. Primary outcome: OS. Secondary outcomes include safety, PFS, PRO (assessed by EORTC QLQ-C30 and EORTC QLQ-OG25 at baseline 4, 8 and 12 weeks until progression) and predictive biomarkers. Pre-specified PRO domains were global quality of life, dysphagia, eating and odynophagia. Analysis by ANCOVA of change in PRO at 4 weeks adjusted for baseline. Results: 450 patients were recruited from 51 UK centres and no difference in OS was detected. There was evidence that PFS was better in the intervention arm (P 35 days, G 49 days; HR=0.795, 95%CI 0.66, 0.96, p=0.017). Questionnaire compliance rates were excellent at baseline (94%) and at 4 weeks (77%). Patients in the gefitinib arm reported significantly better social function (9.26; 95%CI 1.94 to 16.58; p=0.013) and significantly fewer problems with odynophagia (-8.61; 95%CI -14.49 to -2.73; p=0.004), constipation (-15.24; 95%CI -22.83 to -7.65; p=0.0001) and speech (-10.40; 95%CI -16.13 to -4.67; p=0.0004) than patients receiving placebo but more problems with diarrhoea (19.23; 95%CI 11.79 to 26.27; p<0.0001). All other PRO domains were similar between the two groups. Conclusions: Gefitinib did not improve overall survival in esophageal cancer patients after chemotherapy however there was significant PFS improvement and improvement in quality of life and palliation of symptoms albeit with an excess of diarrhoea. Clinical trial information: 29580179.

Biopsy versus resection in the management of malignant gliomas: a systematic review and meta-analysis

2010 ◽  
Vol 112 (5) ◽  
pp. 1020-1032 ◽  
Author(s):  
Abraham Tsitlakidis ◽  
Nicolas Foroglou ◽  
Christos A. Venetis ◽  
Ioannis Patsalas ◽  
Athanasios Hatzisotiriou ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Overall Survival ◽  
Malignant Glioma ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Malignant Gliomas ◽  
Karnofsky Performance Scale ◽  
Significant Difference

Object The aim of this study was to answer the question whether quality of life and progression-free and overall survival are increased in adults with supratentorial malignant glioma who are treated with cytoreductive resection as compared with those who only undergo biopsy. Methods A literature search of the electronic databases MEDLINE, EMBASE, and CENTRAL was performed to identify relevant studies published before May 2008. Hand-searching of reference lists of the identified studies and relevant review articles was also performed. A study was considered eligible, regardless of study design (prospective or retrospective), if: 1) quality of life and/or progression-free and/or overall survival was compared among adult patients undergoing biopsy or resection, and 2) patient age and Karnofsky Performance Scale scores were not significantly different among the 2 groups compared. Results One randomized controlled trial and 4 retrospective studies (involving a total of 1111 patients) were found eligible for this systematic review. A meta-analysis of the eligible studies demonstrated a significant increase in overall survival in the patients treated with resection instead of biopsy (hazard ratio 0.61, 95% CI 0.52–0.71, p < 0.0001, fixed-effect model). Although statistical pooling was not feasible, the available data suggest that quality of life was increased in patients treated with resection rather than biopsy, while there did not seem to be any significant difference in progression-free survival between the 2 groups. Conclusions Based on the best available evidence, it appears that cytoreductive resection in adults with supratentorial malignant glioma is associated with improved overall survival as compared with biopsy. However, well-designed prospective studies are needed for more solid conclusions to be drawn.

scholarly journals Individualized Radiation Dose Escalation Based on the Decrease in Tumor FDG Uptake and Normal Tissue Constraints Improve Survival in Patients With Esophageal Carcinoma

2016 ◽  
Vol 16 (1) ◽  
pp. 75-80 ◽  
Author(s):  
Jinbo Ma ◽  
Zhaoyang Wang ◽  
Chengde Wang ◽  
Ercheng Chen ◽  
Yaozong Dong ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Dose ◽  
Esophageal Carcinoma ◽  
Dose Escalation ◽  
Normal Tissue ◽  
Metabolic Response ◽  
Survival Rates ◽  
Complete Metabolic Response ◽  
Computer Tomography Scan ◽  
Overall Survival Rates

Background: To determine whether individualized radiation dose escalation after planned chemoradiation based on the decrease in tumor and normal tissue constraints can improve survival in patients with esophageal carcinoma. Methods: From August 2005 to December 2010, 112 patients with squamous esophageal carcinoma were treated with radical concurrent chemoradiation. Patients received positron emission tomography-computer tomography scan twice, before radiation and after radiation dose of 50.4 Gy. All patients were noncomplete metabolic response groups according to the Response Evaluation Criteria in solid tumors. Only 52 patients with noncomplete metabolic response received individualized dose escalation based on tumor and normal tissue constraints. Survival and treatment failure were observed and analyzed using SPSS (13.0). Results: The rate of complete metabolic response for patients with noncomplete metabolic response after dose escalation reached 17.3% (9 of 52). The 2-year overall survival rates for patients with noncomplete metabolic response in the conventional and dose-escalation groups were 20.5% and 42.8%, respectively( P = .001). The 2-year local control rates for patients were 35.7% and 76.2%, respectively ( P = .002). When patients were classified into partial metabolic response and no metabolic response, 2-year overall survival rates for patients with partial metabolic response were significantly different in conventional and dose-escalation groups (33.8% vs 78.4%; P = .000). The 2-year overall survival rates for patients with no metabolic response in two groups (8.6% vs 15.1%) did not significantly differ ( P = .917). Conclusion: Individualized radiation dose escalation has the potential to improve survival in patients with esophageal carcinoma according to increased rate of complete metabolic response. However, further trials are needed to confirm this and to identify patients who may benefit from dose escalation.

Effect of weight loss on survival in esophageal cancer patients undergoing neoadjuvant chemoradiotherapy and surgery.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24076-e24076
Author(s):  
Tao Li
Keyword(s):  
Overall Survival ◽  
Weight Loss ◽  
Esophageal Cancer ◽  
Esophageal Carcinoma ◽  
Survival Rates ◽  
Neoadjuvant Chemoradiotherapy ◽  
Severe Weight Loss ◽  
Low Weight ◽  
Weight Loss Group ◽  
Overall Survival Rates

e24076 Background: This study aimed to determine the impact of weight loss during neoadjuvant chemoradiotherapy on the survival of patients with esophageal carcinoma. Methods: We retrospectively examined 102 consecutive patients with esophageal carcinoma who underwent neoadjuvant chemoradiotherapy followed by radical resection at Sichuan Cancer Hospital & Institute between 2003 and 2017. The patients were divided into three groups based on the amount of body weight lost during neoadjuvant chemoradiotherapy: severe weight loss (>10%), high weight loss (5%–10%), and low weight loss (<5%). The correlations of weight loss with toxicity, progression-free survival, and overall survival were investigated. Results: The median overall survival was 49.7 months in the low weight loss group compared with 35.4 and 25.1 months in the high and severe weight loss groups ( P = 0.041). The 1-year overall survival rates in the severe, high, and low weight loss groups were 62.5%, 85.0%, and 90.7%, respectively; the corresponding 3-year overall survival rates were 21.9%, 47.3%, and 68.8%, respectively, and the corresponding 5-year overall survival rates were 21.9%, 31.0%, and 44.4%, respectively. The multivariate analysis indicated that a pathological complete response and severe weight loss were independent prognostic factors for overall survival. Any leukopenia ( P = 0.024), leukopenia of at least grade 3 ( P = 0.021), and anemia ( P = 0.042) occurred more frequently in the severe weight loss group. Conclusions: Weight loss during neoadjuvant CRT is an independent and adverse prognostic factor in esophageal carcinoma patients, whereas a stable weight confers a better prognosis. Keywords: esophageal cancer, prognosis, weight loss, neoadjuvant chemoradiotherapy, toxicity.

scholarly journals Prognostic and Clinical Value of CD44 and CD133 in Esophageal Cancer: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Aseel Kamil Mohammed Al-mosawi ◽  
Hamid Cheshomi ◽  
Ali Hosseinzadeh ◽  
Maryam M. Matin
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Web Of Science ◽  
Meta Analysis ◽  
Survival Rates ◽  
Clinicopathological Features ◽  
Clinical Value ◽  
Node Metastasis ◽  
Hazard Ratios ◽  
Funnel Plots

Despite the importance of CD44 and CD133 in various cancers, the clinicopathological and prognostic values of these biomarkers in esophageal cancer remain debated. Hence, in this study, we did a meta-analysis to explore the correlation between overexpression of these markers and some clinicopathological features and their influence on the survival of esophageal cancer patients. A search in PubMed and Web of Science (among all articles published up to January 16, 2018) was done using the following keywords: esophageal cancer, CD44, CD133, prominin-1, AC133. Suitable studies, that were selected based on the criteria listed in the Materials and Methods section, were chosen and hazard ratios with 95% confidence intervals were estimated if available. Heterogeneity and sensitivity were also analyzed. Furthermore, publication bias was assessed using funnel plots, Egger, and Begg tests. The study included 1346 patients from 13 related studies. The median rates of marker expressions by immunohistochemistry were 35.7% (30%-76.6%) from 9 studies for CD44 and 31.9% (21%–44.2%) from 5 studies for CD133. The accumulative 5-year overall survival rates of CD44-positive and CD133-positive were 1.59% (1.22-2.06) and 1.27% (0.93-1.73), respectively. Meta-analysis showed that CD44 expression had a significant correlation with 5-year overall survival. CD44 overexpression showed a correlation with some clinicopathological features such as lymph node metastasis, vascular invasion, and recurrence of the disease, while it was not the case for coexpression of CD44 and CD133. In conclusion, CD44 overexpression was associated with a 5-year overall survival rate and thus this biomarker can be a suitable prognostic tool in esophageal cancer.

scholarly journals Simultaneous implant placement with autogenous onlay bone grafts: a systematic review and meta-analysis

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Guoqiang Ma ◽  
Chaoan Wu ◽  
Miaoting Shao
Keyword(s):  
Meta Analysis ◽  
Survival Rates ◽  
Bone Grafts ◽  
Implant Survival ◽  
Analysis Model ◽  
Implant Placement ◽  
Significant Difference ◽  
Delayed Implant Placement ◽  
Onlay Grafts

AbstractSeveral authors have suggested that implants can be placed simultaneously with onlay bone grafts without affecting outcomes. Therefore, the purpose of this study was to answer the following clinical questions: (1) What are the outcomes of implants placed simultaneously with autogenous onlay bone grafts? And (2) is there a difference in outcomes between simultaneous vs delayed placement of implants with autogenous onlay bone grafts? Databases of PubMed, Embase, and Google Scholar were searched up to 15 November 2020. Data on implant survival was extracted from all the included studies (single arm and comparative) to calculate point estimates with 95% confidence intervals (CI) and pooled using the DerSimonian–Laird meta-analysis model. We also compared implant survival rates between the simultaneous and delayed placement of implants with data from comparative studies. Nineteen studies were included. Five of them compared simultaneous and delayed placement of implants. Dividing the studies based on follow-up duration, the pooled survival of implant placed simultaneously with onlay grafts after <2.5 years of follow-up was 93.1% (95% CI 82.6 to 97.4%) and after 2.5–5 years was 86% (95% CI 78.6 to 91.1%). Implant survival was found to be 85.8% (95% CI 79.6 to 90.3%) with iliac crest grafts and 95.7% (95% CI 83.9 to 93.0%) with intra-oral grafts. Our results indicated no statistically significant difference in implant survival between simultaneous and delayed placement (OR 0.43, 95% 0.07, 2.49, I2=59.04%). Data on implant success and bone loss were limited. Data indicates that implants placed simultaneously with autogenous onlay grafts have a survival rate of 93.1% and 86% after a follow-up of <2.5 years and 2.5–5years respectively. A limited number of studies indicate no significant difference in implant survival between the simultaneous and delayed placement of implants with onlay bone grafts. There is a need for randomized controlled trials comparing simultaneous and delayed implant placement to provide robust evidence.

scholarly journals The Anti-PD-1/PD-L1 Immunotherapy for Gastric Esophageal Cancer: A Systematic Review and Meta-Analysis and Literature Review

2021 ◽  
Vol 28 ◽  
pp. 107327482199743
Author(s):  
Ke Chen ◽  
Xiao Wang ◽  
Liu Yang ◽  
Zheling Chen
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Survival Rate ◽  
Meta Analysis ◽  
Response Rates ◽  
Control Group ◽  
Term Survival ◽  
Long Term Survival ◽  
And Control

Background: Treatment options for advanced gastric esophageal cancer are quite limited. Chemotherapy is unavoidable at certain stages, and research on targeted therapies has mostly failed. The advent of immunotherapy has brought hope for the treatment of advanced gastric esophageal cancer. The aim of the study was to analyze the safety of anti-PD-1/PD-L1 immunotherapy and the long-term survival of patients who were diagnosed as gastric esophageal cancer and received anti-PD-1/PD-L1 immunotherapy. Method: Studies on anti-PD-1/PD-L1 immunotherapy of advanced gastric esophageal cancer published before February 1, 2020 were searched online. The survival (e.g. 6-month overall survival, 12-month overall survival (OS), progression-free survival (PFS), objective response rates (ORR)) and adverse effects of immunotherapy were compared to that of control therapy (physician’s choice of therapy). Results: After screening 185 studies, 4 comparative cohort studies which reported the long-term survival of patients receiving immunotherapy were included. Compared to control group, the 12-month survival (OR = 1.67, 95% CI: 1.31 to 2.12, P < 0.0001) and 18-month survival (OR = 1.98, 95% CI: 1.39 to 2.81, P = 0.0001) were significantly longer in immunotherapy group. The 3-month survival rate (OR = 1.05, 95% CI: 0.36 to 3.06, P = 0.92) and 18-month survival rate (OR = 1.44, 95% CI: 0.98 to 2.12, P = 0.07) were not significantly different between immunotherapy group and control group. The ORR were not significantly different between immunotherapy group and control group (OR = 1.54, 95% CI: 0.65 to 3.66, P = 0.01). Meta-analysis pointed out that in the PD-L1 CPS ≥10 sub group population, the immunotherapy could obviously benefit the patients in tumor response rates (OR = 3.80, 95% CI: 1.89 to 7.61, P = 0.0002). Conclusion: For the treatment of advanced gastric esophageal cancer, the therapeutic efficacy of anti-PD-1/PD-L1 immunotherapy was superior to that of chemotherapy or palliative care.

scholarly journals Effects of n-3 Polyunsaturated Fatty Acid Supplementation in the Prevention and Treatment of Depressive Disorders—A Systematic Review and Meta-Analysis

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1070
Author(s):  
Maike Wolters ◽  
Annkathrin von der Haar ◽  
Ann-Kristin Baalmann ◽  
Maike Wellbrock ◽  
Thomas L. Heise ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Treatment Duration ◽  
Depressive Disorders ◽  
Meta Analysis ◽  
Pufa Supplementation ◽  
Depressive Symptomology ◽  
Beneficial Effects ◽  
Randomized Controlled ◽  
Significant Difference

N-3 polyunsaturated fatty acids (PUFAs) have been suggested to affect depressive disorders. This review aims to determine the effect of n-3 PUFAs on depressive symptoms in people with or without diagnosed depression. Medline, PsycINFO, and Cochrane CENTRAL databases were searched for randomized controlled trials (RCTs) assessing the association between n-3 PUFAs and depressive symptoms or disorders as outcomes. A random-effects meta-analysis of standardized mean difference (SMD) with 95% confidence intervals (CI) was performed. Twenty-five studies (7682 participants) were included. Our meta-analysis (20 studies) indicated that n-3 PUFA supplementation lowered depressive symptomology as compared with placebo: SMD = −0.34, 95% CI: −0.55, −0.12, I2 = 86%, n = 5836, but a possible publication bias cannot be ruled out. Subgroup analyses indicated no statistically significant difference by treatment duration of <12 vs. ≥12 weeks, presence of comorbidity, or severity of depressive symptoms. Nevertheless, beneficial effects were seen in the subgroups of studies with longer treatment duration and with no depression and mild to moderate depression. Subgroup analysis by eicosapentaenoic acid (EPA) dosage revealed differences in favor of the lower EPA dosage. Sensitivity analysis including studies with low risk of bias seems to confirm the overall result. Supplementation of n-3 PUFA appears to have a modest beneficial effect on depressive symptomology, although the quality of evidence is still insufficient.

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