Table 1.
Basic characteristicsof the included studies
| Author | Year | Nation | Case number | Regimen of radiotherapy | Surgery | Therapeutic effect evaluation | Quality evaluation | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | |||||||
| Castoro et al.14 | 2013 | Italy | 77 | Standard RT was usually performed in 1.8 Gy daily fractions for a total dose of 45–50 Gy. The PTV included the primary tumor, with 5cm longitudinal margins; metastatic nodes, with 2cm margins; supraclavicular fovea; and mediastinum | Surgery was performed 4–6 weeks after the completion of neoadjuvant treatment | CR for the primary tumor was defined as the disappearance of the tumor lesion, ulceration, and the absence of carcinoma cells in biopsy specimens upon endoscopic observation of the entire esophagus. CR for lymph nodes was defined according to the RECIST. CT (and PET/CT from 2005) scans were performed to rule out distant metastasis | 1 | 1 | 1 | 0 | 1 |
| Piessen et al.15 | 2013 | France | 257 | All patients underwent standardized radiotherapy: GTV was determined on the basis of clinical examination, planning CT, endoscopy, and EUS. All patients were treated with conformational 3D RT, with more than 6 MV X‐ray. Dose distribution was calculated by treatment planning system. Portal imaging was performed once a week | Curative surgical resection consisted of a transthoracic en bloc esophagectomy, including an abdominal and an extended mediastinal lymphadenectomy | cCR was defined when all of the following were present: absence of tumor residue visible by endoscopy, negative endoscopic biopsy; and on CT scan, the absence of a residual tumor, lymph nodes of more than 10mm in diameter, and metastasis. When a PET scan was performed, CMR was considered when having a physiologic level of SUVmax or when the SUVmax was higher than normal but was distributed in an esophagitis pattern | 1 | 1 | 1 | 1 | 0 |
| Chao et al.16 | 2013 | Taiwan | 160 | Radiation therapy between days 8 and 29 consisted of a total dose of 30 Gy, administered in daily fractions of 200 Gy, five days/week | The standard surgical approach was limited thoracotomy on the right side and intrathoracic gastric tube reconstruction (Ivor–Lewis procedure) for lesions of the middle and lower one‐third of the esophagus. Lesions of the upper one‐third of the esophagus/cervical lesions were treated by neck anastomosis (McKeown procedure) | Endoscopic CR was tentatively defined upon endoscopic observation of the entire esophagus as: the disappearance of the tumor lesion and ulceration, and the absence of carcinoma cells in biopsy specimens plus image evaluation of the regional lymph node and distant sites (by RECIST) | 1 | 1 | 1 | 0 | 0 |
| Jeong et al.17 | 2014 | Korea | 154 | The total radiation dose was 46 Gy for preoperative CRT and 54 Gy for definitive CRT (2 Gy per daily fraction, five days per week). In the definitive CRT group, a boost dose of 10 Gy in 5 fractions was added to the volume containing the GTV with 2cm of radial and longitudinal margins after administration of 44 Gy in 22 fractions | Of the 73 patients in the trimodality group, 72 underwent transthoracic esophagectomy and 1 underwent transhiatal esophagectomy | Metabolic complete remission (PET‐CR) was defined as FDG uptake of the primary tumor and lymph nodes were decreased and were indistinguishable from the surrounding normal tissue | 1 | 1 | 1 | 1 | 1 |
cCR, clinical complete response (cCR); CMR, complete metabolic response; CT, computed tomography; EUS, endoscopic ultrasound; FDG, 18F‐fluorodeoxyglucose; GTV, gross tumor volume; PET, positron emission tomography; PTV, planning target volume; RECIST, Response Evaluation Criteria in Solid Tumors; RT, radiotherapy; SUVmax, maximum standardized uptake value.