Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Mar 24, 2025; 16(3): 101251
Published online Mar 24, 2025. doi: 10.5306/wjco.v16.i3.101251
Safety and effectiveness of induction chemoimmunotherapy followed by definitive radiotherapy or concurrent chemoradiotherapy in esophageal squamous cell carcinoma
Zhuo-Jun Wei, Lin Wang, Rui-Qi Wang, Yu Wang, Huan Chen, Hong-Lian Ma, Yu-Jin Xu
Zhuo-Jun Wei, Lin Wang, Rui-Qi Wang, Yu Wang, Huan Chen, Hong-Lian Ma, Yu-Jin Xu, Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China
Zhuo-Jun Wei, School of Medicine, Shaoxing University, Shaoxing 312000, Zhejiang Province, China
Author contributions: Wei ZJ generated conception, designed the study, and analyzed data; Xu YJ contributed to administrative support; Wei ZJ, Wang L, Wang RQ, Wang Y, Chen H, Ma HL, and Xu YJ provided study materials, collected the data, and wrote the manuscript; and all authors read and approved the final version.
Supported by Natural Science Foundation of Zhejiang Province, China, No. LGF21H160005; and Zhejiang Medical and Health Science and Technology Project, China, No. 2024KY049.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Zhejiang Cancer Hospital [Approval No. IRB-2024-223 (IIT)].
Informed consent statement: This research is a retrospective study. Patients were not required to provide informed consent for this study because the analysis used anonymous clinical data that were obtained after patient had agreed to treatment with written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Jin Xu, PhD, Professor, Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, No.1 East Banshan Road, Gongshu District, Hangzhou 310022, Zhejiang Province, China. xuyj@zjcc.org.cn
Received: September 9, 2024
Revised: December 1, 2024
Accepted: December 25, 2024
Published online: March 24, 2025
Processing time: 134 Days and 4.9 Hours
Abstract
BACKGROUND

Esophageal squamous cell carcinoma (ESCC) is a common malignancy in China, often diagnosed at an advanced stage, with poor prognosis. Standard treatments such as definitive chemoradiotherapy offer limited survival benefits. Recent advances in immune checkpoint inhibitors combined with chemotherapy have shown promise, but their effectiveness and safety in conjunction with radiotherapy for unresectable ESCC require further exploration.

AIM

To assess the safety and effectiveness of induction chemoimmunotherapy followed by definitive radiotherapy or concurrent chemoradiotherapy (CCRT) in locally advanced unresectable ESCC.

METHODS

This retrospective study included 80 patients with locally advanced unresectable ESCC who underwent induction chemoimmunotherapy followed by definitive radiotherapy, recruited from Zhejiang Cancer Hospital. All patients received 2-4 cycles of chemotherapy plus programmed cell death 1/programmed cell death ligand 1 inhibitor, were re-evaluated to be inoperable, then received definitive radiotherapy or CCRT. Primary endpoint was treatment safety and tolerance. SPSS 26.0 software was used for data analysis. Th Kaplan-Meier method was used for survival analysis.

RESULTS

Thirty-seven (46.3%) patients received CCRT and 43 (53.7%) received radiotherapy alone. The most common treatment-related adverse events included radiation esophagitis (32/80, 40.0%) and anemia (49/80, 61.3%), with 22 (27.5%) experiencing grade ≥ 3 adverse events. No treatment-related deaths occurred. After median follow-up of 16.5 months, the median progression-free survival (PFS) was 14.2 months, and median overall survival (OS) was 19.9 months. The 1-year and 2-year PFS and OS were 55.8% and 31.6%, and 67.5% and 44.1%, respectively. Patients with partial response had better outcomes than those with stable disease: 1-year PFS 69.4% vs 43.9% (P = 0.011) and OS 83.2% vs 48.8% (P = 0.007). Induction therapy effectiveness and immunotherapy maintenance were independent prognostic factors for OS.

CONCLUSION

Chemotherapy combined with programmed cell death 1/programmed cell death ligand 1 inhibitor followed by definitive radiotherapy or CCRT in patients with locally advanced ESCC was safe and effective.

Keywords: Esophageal squamous cell carcinoma; Radiotherapy; Immune checkpoint inhibitors; Chemotherapy; Patient safety; Treatment outcome

Core Tip: This study highlighted the safety and effectiveness of combining induction chemotherapy with programmed cell death 1/programmed cell death ligand 1 inhibitors followed by definitive radiotherapy or chemoradiotherapy, for locally advanced unresectable esophageal squamous cell carcinoma. It identified induction therapy effectiveness and maintenance immunotherapy as key prognostic factors, emphasizing the need for further validation through prospective trials.