A preliminary analysis of chemoradiotherapy combined with immunotherapy as first-line treatment for locally advanced or metastatic esophageal squamous cell carcinoma
10.3760/cma.j.cn112271-20230221-00048
- VernacularTitle:放化疗联合免疫一线治疗局部晚期或转移性食管鳞癌的初步分析
- Author:
Youmei LI
1
;
Shuguang LI
;
Chunyang SONG
;
Xiaohan ZHAO
;
Wenzhao DENG
;
Jingyuan WEN
;
Jinrui XU
;
Shuchai ZHU
;
Wenbin SHEN
Author Information
1. 河北医科大学第四医院放疗科，石家庄 050011
- Keywords:
Esophageal squamous cell carcinoma;
Chemoradiotherapy;
Immunotherapy;
Prognosis;
Failure mode
- From:
Chinese Journal of Radiological Medicine and Protection
2023;43(10):766-773
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy and prognostic factors of radiotherapy combined with immunotherapy as the first-line treatment for patients with locally advanced or metastatic esophageal squamous cell carcinoma (LA/M ESCC).Methods:A single-center, retrospective analysis was conducted for the recent efficacy, survival, prognostic factors, post-treatment failure modes, and treatment-related adverse reactions of 57 LA/M ESCC patients eligible for enrollment.Results:The entire group of patients had 1-, 2-, and 3-year overall survival (OS) of 86.0%, 57.5%, and 53.9%, respectively and 1-, 2-, and 3-year progression-free survival (PFS) of 61.4%, 31.0%, and 31.0%, respectively. The median OS was not reached, and the median PFS was 15.0 (95% CI: 10.77-19.23) months. These patients had an overall response rate (ORR) of 80.7% (46/57) and a disease control rate (DCR) of 94.7% (54/57). As indicated by the result of the multivariate analysis, the independent prognostic factors affecting the OS of the patients included their age, clinical stage, number of immunotherapy cycles, and recent efficacy ( HR = 0.25, 2.58, 0.35, 4.05, P < 0.05), and the independent factors influencing the PFS of the patients included their clinical stage and recent efficacy ( HR = 2.27, 1.97, P < 0.05). There were no statistically significant differences in the effects of irradiation ranges and the combination modes of immunologic drugs and chemoradiotherapy on both OS and PFS of the patients ( P > 0.05). A total of 32 patients suffered post-treatment failure. After the second treatment, they had 1- and 2-year OS of 55.7% and 25.3%, respectively, with median OS of 14.0 (95% CI: 5.17-22.83) months. A total of 26 cases experienced treatment-associated adverse reactions of grades 2 or higher during and after treatment. Conclusions:The combination of radiotherapy and immunotherapy is effective and safe as the first-line treatment for LA/M ESCC patients. The post-treatment failure modes still include local recurrence and distant metastasis. Therefore, such combination merits further investigation.
