Evidence map›Paper›PMID 40838203›Full record

ArticleEClinicalMedicine2025

Radiation dose escalation in locally advanced oesophageal cancer: a systematic review and hierarchical Bayesian meta-analysis.

Yang-Hong Dai, Po-Huang Chen, Yi-Jhih Huang, Ding-Jie Lee, Po-Chien Shen, Cheng-Hsiang Lo, Yu-Guang Chen, Yu-Fu Su, Jen-Fu Yang, Ying-Fu Wang and 4 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in EClinicalMedicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Dosimetry-Driven Personalization of Radiopharmaceutical Therapies: Evidence and Opportunities.Journal of nuclear medicine : official publication, Society of Nuclear Medicine · 2026
    Review
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Yang-Hong DaiDepartment of Oncology, University of Oxford, Oxford, UK.
Po-Huang ChenDivision of Haematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.
Yi-Jhih HuangDepartment of Oncology, University of Oxford, Oxford, UK.
Ding-Jie LeeDivision of Nephrology, Department of Internal Medicine, Tri-Service General Hospital Keelung Branch, National Defense Medical University, Taiwan.
Po-Chien ShenDepartment of Radiation Oncology, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.
Cheng-Hsiang LoDepartment of Radiation Oncology, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.
Yu-Guang ChenDivision of Haematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.
Yu-Fu SuDepartment of Radiation Oncology, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.
Jen-Fu YangDepartment of Radiation Oncology, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.
Ying-Fu WangDepartment of Radiation Oncology, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.
Wen-Yen HuangDepartment of Radiation Oncology, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.
Chun-Shu LinDepartment of Radiation Oncology, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.
Chih-Cheng TsaoDepartment of Radiation Oncology, Taitung MacKay Memorial Hospital, Taitung, Taiwan.
Katherine A VallisDepartment of Oncology, University of Oxford, Oxford, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: The impact of radiation dose escalation in locally advanced oesophageal cancer remains controversial. While higher doses may improve locoregional control, their effect on overall survival (OS) and progression-free survival (PFS) remains uncertain. The aim of this study was to thoroughly evaluate the impact of dose escalation on survival. Methods: A systematic search on Jan 4, 2025, identified studies evaluating definitive chemoradiotherapy (CRTx) for locally advanced oesophageal cancer stratified by radiation dose. Bayesian and frequentist meta-analyses assessed OS, PFS, and locoregional PFS (LRPFS). Meta-regression examined the influence of histology, tumour location, chemotherapy, and radiation techniques. Additional analyses included gene set enrichment analysis and immune infiltration estimation. This study is registered with PROSPERO, CRD42024538961. Findings: A total of 42 studies involving 8379 patients were included. High-dose radiotherapy significantly improved LRPFS, with the largest benefit observed at 1-year (median difference: 18.6%; 95% credible interval [CrI]: 10.7-26.1%). A modest improvement in OS was noted at 3-year (7.0%; 95% CrI: 0.01-13.9%), particularly in squamous cell carcinoma (SqCC). Meta-regression identified SqCC and taxane-based chemotherapy as key moderators, with high-dose conferring greater benefits in Asian populations. Genomic analysis revealed higher radiosensitivity and significant immune activation in Asian SqCC. Taxane-based chemotherapy regimens were the strongest predictors of 1-/2-year OS and PFS but diminished at 5-year. Any-grade pneumonitis was more common in high-dose, but frequencies of grade 3 or higher pneumonitis were similar. Modern techniques like intensity-modulated or volumetric-modulated radiotherapy were associated with higher complete response rate and a trend toward reduced toxicity. The study heterogeneity was moderate to high across pooled estimates but addressed through hierarchical modeling and subgroup/sensitivity analyses. Most included studies were retrospective with moderate risk of bias, and the certainty of evidence for primary outcomes was rated as low to high. Interpretation: Radiation dose escalation improves locoregional control and may enhance OS in SqCC, particularly in Asian populations, highlighting the need for histology- and region-specific therapeutic strategies. The choice of chemotherapy regimen may affect the interpretation of survival effects associated with high-dose. Furthermore, the genomic correlates of radiosensitivity and immune activation suggest potential for biologically guided dose personalization and combination with immunotherapy. Funding: None.

Indexed as

Bayesian meta-analysisChemoradiotherapyDose escalationOesophageal cancerRadiation therapySquamous cell carcinomaSurvival outcomes

Identifiers

PMID40838203
PMCPMC12362008

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.