Infrequent chemoradiation-induced acute esophagitis in the Asian population: A meta-analysis of published clinical trials for unresectable stage III non-small cell lung cancer

Severe (grade 3 or higher) esophagitis is one of the major toxicities for chemoradiation in the treatment of stage III non-small cell lung cancer (NSCLC). The difference among ethnic groups has never been investigated in detail. Prospective trials with concurrent platinum-containing chemoradiation in unresectable disease were investigated, and a total of 116 treatment arms with 7520 patients were identified. Univariate analysis demonstrated that treatment arms conducted in Asia had significantly lower incidence of severe esophagitis (170/2534, 6.7%, odds ratio 0.289) than in other nations (1025/4986, 20.6%). In the multivariable model, Asian/non-Asian ethnicity, multi-/single-agent, and split are jointly significant predictors after adjusting for all possible factors. This study suggests that severe esophagitis occurs less frequently in the Asian population compared to the non-Asian population.