Wen-Bin Shen

The optimal radiotherapy dose for cervical and upper thoracic esophageal cancer (ESCA) remains controversial, with limited evidence supporting dose escalation. This study aims to evaluate the survival impact of varying radiotherapy doses and explore potential benefits in specific patient subgroups using multicenter real-world data.Data from 2,527 inoperable cervical and upper thoracic ESCA patients treated with IMRT/3DCRT across eight medical centers in China during 1st June 2004 and 1st June 2020 were retrospectively analyzed. Patients were divided into low-dose (50–<60 Gy) and high-dose (≥ 60 Gy) groups. Subgroup analyses were conducted to identify populations that might benefit from higher doses.High-dose radiotherapy (≥ 60 Gy) improved overall survival (OS) in cervical ESCA patients before and after propensity score matching (P = 0.026 and P = 0.047). For upper thoracic ESCA, high-dose radiotherapy showed a survival advantage before matching (P = 0.008), though not after (P = 0.680). Subgroup analysis revealed survival benefits in upper thoracic ESCA patients with poor performance status (KPS < 90), those not receiving chemotherapy (P = 0.043 and P = 0.013), and borderline improvement in patients with smaller gross tumor volumes (< 35.1 cm³, P = 0.057). Radiation doses exceeding 63 Gy provided no additional survival benefit compared to 60–63 Gy.High-dose radiotherapy (≥ 60 Gy) significantly improves survival in cervical ESCA patients. Subgroup analysis highlights its potential benefits for upper thoracic ESCA patients with KPS < 90, those not receiving chemotherapy, and those with smaller tumor volumes (< 35.1 cm³).

Objective: This study was designed to investigate the efficacy and prognostic factors for immune checkpoint inhibitors (ICIs) combined with or without radio(chemo)therapy and to evaluate their toxicity in patients with locally advanced or recurrent/metastatic esophageal squamous cell carcinoma (LA/RM ESCC). Methods: In this study, 198 patients with locally advanced or recurrent/metastatic (LA/RM) ESCC who received ICIs combined with or without radiotherapy/chemotherapy in the Department of Radiotherapy of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. Univariate and multivariate analyses were performed to determine the prognostic factors for overall survival (OS) and progression free survival (PFS). The factors affecting treatment response and the occurrences of treatment-related adverse events (trAEs) were analyzed. Results: The median OS and PFS were 30.4 months (95% confidence interval [CI] 15.1–45.7 months) and 15.3 months (95% CI 12.8–17.8 months), respectively. Univariate and multivariate analysis showed that the number of ICI cycles, the intervention of radiotherapy and dysphagia were independent factors affecting OS (Hazard ratio [HR] = 0.39, 2.043 and 0.365, respectively; P = 0.018, 0.001 and 0.032, respectively). The intervention of radiotherapy was an independent factor for PFS (hazard ratio [HR] = 18.149, P = 0.013). The median OS and PFS for patients who had complete response and partial response (Objective response, ORR) were 50.8 months (95% CI 25.8–75.7 months) and 20.5 months (95% CI 14.1–27.0), respectively, which were significantly higher than those in the non-ORR group (OS_non-ORR:17.5 months, 95% CI 14.0–21.0; χ² = 13.881, P < 0.001; PFS_non-ORR: 12.1 months, 95% CI 10.1–14.1, χ² = 10.676, P = 0.001). The intervention of radiotherapy could improve treatment response (χ² = 47.725, P = 0.000). In entire study population, 83 patients (41.9%) had ≥ grade 2 trAEs. Conclusions: ICIs combined with radiotherapy/chemotherapy are safe and effective in LA/RM ESCC patients. Intervention of radiotherapy, the number of immunotherapy cycles and occurrence of dysphagia affecting the overall survival of LR/RM ESCC patients. Intervention of radiotherapy was an independent prognosis factor for OS and PFS and associated with better treatment response.

Objective: This study was designed to investigate the prognostic factors for immune checkpoint inhibitors (ICIs) combined utilization with radiotherapy (RT)/chemoradiotherapy (CRT) and to evaluate their toxicity in locally advanced or recurrent/metastatic esophageal squamous cell carcinoma (LA/RM ESCC). Methods: In this study, 198 LA/RM ESCC patients who received ICIs combined with RT/CRT in the Department of Radiotherapy of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. Univariate and multivariate analyses were performed to determine the prognostic factors for overall survival (OS) and progression-free survival (PFS). Subgroup analysis was utilized to explore the prognostic factors, the treatment respond and treatment-related adverse events (trAEs) were analyzed. Results: The median OS and PFS were 30.4 months (95% confidence interval [CI]: 15.1–45.7 months) and 15.3 months (95% CI: 12.8–17.8 months), respectively. The median OS and PFS for patients achieving objective respond (ORR group, including complete response and partial response) were 50.8 months (95% CI: 25.8–75.7 months) and 20.5 months (95% CI: 14.1–27.0), respectively, which were higher than those in non-ORR group (OS_non-ORR:17.5 months, 95% CI: 14.0–21.0; χ² = 13.881, P < 0.001; PFS_non-ORR: 12.1 months, 95% CI: 10.1–14.1, χ² = 10.676, P = 0.001). Results from subgroup analysis illustrated combined ICIs with radiotherapy could improve the treatment respond (χ² = 47.725, P = 0.000). The OS rate (χ² = 18.836, P < 0.001) and PFS rate (χ² = 6.881, P = 0.009) were significantly higher in the whole-lesion radiotherapy group than in the partial-lesion radiotherapy group. Multivariate analysis showed that the number of immune cycles, the coverage of radiotherapy target, the modality of ICIs-combination therapy and treatment response were independent prognosis factors for OS (hazard ratio [HR] = 0.512, 2.043, 1.889, and 1.912, respectively; P = 0.001, 0.001, 0.013, and 0.002, respectively). Radiotherapy coverage and treatment response were independent factors for PFS (HR = 1.478 and 1.597, respectively; P = 0.032 and 0.012, respectively). In the entire study population, 83 patients (41.9%) had ≥ grade 2 trAEs. Conclusions: ICIs combined with radiotherapy/chemoradiotherapy are safe and effective in LA/RM ESCC patients. The addition of radiotherapy could improve the treatment respond and whole-lesion radiotherapy improve prognosis compared with partial-lesion radiotherapy group. The number of immunotherapy cycles and treatment response are the main factors affecting prognosis.