Meta-analysis of the efficacy and toxicity of paclitaxel combined with platinum (PTX) and fluorouracil combined with cisplatin (PF) in the treatment of concurrent chemoradiotherapy (CCRT) for unresectable esophageal cancer

Abstract Purpose To systematically evaluate the efficacy and toxicity of paclitaxel/docetaxel combined with platinum (PTX) and fluorouracil combined with cisplatin (PF) in concurrent chemoradiotherapy (CCRT) treatment of unresectable esophageal cancer. Methods PubMed, the CNKI database, and Google Scholar were searched by combining subject words and free words through December 31, 2020; quality evaluation and data extraction of the studies that met the inclusion criteria were carried out independently. Stata 11.1 software was used for the meta-analysis comparing the efficacy and treatment-related toxicity of the two regimens. Result After screening, a total of 10 studies were included: four were cohort studies, and six were randomized controlled studies (RCT). A total of 1,098 cases were enrolled comprising 1,047 cases (95.4%) of squamous cell carcinoma and 51 cases (4.6%) of adenocarcinoma; 560 cases (51.0%) in the PTX group and 538 cases (49.0%) in the PF group. There was no significant difference in hematological toxicity, gastrointestinal reaction, or radiation pneumonia between the two groups (P = 0.353, 0.741, and 0.321). Radiation esophagitis from the PF regimen was the most serious (P = 0.002). In terms of short-term efficacy, the CR rate of the PTX group was higher than that of PF group (P = 0.029). There was no significant difference in PR rate, ORR rate, or DCR(Disease Control Rate) rate between the two groups (P = 0.599, 0.057, and 0.164). In terms of overall survival rate, the 1-, 2- and 3-year survival rates of the PTX group were higher than those of PF group (P = 0.048, 0.029, and 0.001). There was no significant difference in the 5-year survival rate between the two regimens (P = 0.076). PFS of the PTX group at 1, 2, and 3 years was higher than that of PF group (P = 0.023, < 0.001, and 0.014). Conclusions Compared with the PF regimen, the PTX regimen combined with radiotherapy in the CCRT treatment of unresectable esophageal cancer exhibited benefits in clinical CR rate, OS rate, and PFS rate. There was no difference in hematological toxicity, gastrointestinal reaction, or acute radiation pneumonia between the two regimens. The PTX regimen had lower esophageal toxicity and therefore might be the preferred concurrent chemotherapy regimen for esophageal squamous cell carcinoma.