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Published on: April 20, 2018
Radiation dose and pathological complete response rate of neoadjuvant chemoradiotherapy for esophageal squamous cell
Yian Jiang1,2, Tianyu Su3, Qi Li1,2
1Wenzhou Medical University, 325000, Wenzhou, Zhejiang, China.
Purpose:
Evidence characterizing the radiotherapy dose-response relationship to inform dose selection remains limited. Using the biologically effective dose (BED), we conducted a systematic review and model-based analysis of published cohorts to examine associations between radiation dose, pathological complete response (pCR), and overall survival (OS) in esophageal squamous cell carcinoma (ESCC) patients receiving neoadjuvant chemoradiotherapy (nCRT).
Materials And Methods:
PubMed-indexed studies published before November 2025 were included if they enrolled ≥ 20 ESCC patients treated with nCRT and reported stratified radiotherapy dose/fractionation with pCR outcomes. Dose intensity was standardized using BED (linear quadratic model, α/β = 10 Gy). Grouped quasibinomial logistic regression models assessed the BED-pCR association after adjustment for prespecified cohort-level covariates. The cohort-level association between pCR and 2‑year OS was evaluated using weighted correlation.
Results:
A total of 65 studies comprising 74 dose-stratified cohorts and 5235 ESCC patients treated with nCRT were included. Multivariable analyses showed that both BED and radiotherapy technique were independently associated with pCR in ESCC patients. Within the observed BED range, for every 10-Gy increase in BED, the odds of pCR increased (odds ratio [OR] = 1.39, 95% confidence interval [CI] 1.13-1.70; P = 0.002). Compared with two-dimensional conformal radiotherapy (2D-CRT), three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) were associated with higher pCR rates. At the cohort level, pCR rates showed a positive association with 2‑year OS (weighted Pearson's r = 0.519).
Conclusion:
A model integrating BED and radiotherapy technique provides cohort-level estimates of pCR in ESCC patients receiving nCRT. These findings provide a quantitative framework for future prospective studies evaluating dose optimization in this setting.