Preliminary analysis of chemoradiotherapy combined with immunotherapy in patients with recurrent or metastatic esophageal squamous cell carcinoma
10.3760/cma.j.cn112271-20240108-00007
- VernacularTitle:放化疗联合免疫治疗复发转移性食管鳞癌患者的初步分析
- Author:
Yufang WANG
1
;
Meirong LIU
Author Information
1. 聊城市人民医院放疗科，聊城 252000
- Keywords:
Esophageal squamous cell carcinoma;
Second-line treatment;
Immune checkpoint inhibitors;
Radiotherapy/chemotherapy;
Prognosis
- From:
Chinese Journal of Radiological Medicine and Protection
2024;44(9):749-757
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy of radiotherapy/chemotherapy combined with immune checkpoint inhibitors (ICIs) in patients with locally recurrent or metastatic esophageal squamous cell carcinoma (LR/M ESCC) after first-line radical treatment.Methods:A retrospective analysis was conducted on 116 enrolled patients with LR/M ESCC. Factors influencing patient prognosis were analyzed, and a stratified analysis was performed focusing on inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) before second-line treatment, the intervention timing and extent of radiotherapy, and treatment efficacy. Additionally, treatment-related adverse effects with grade ≥2 and failure patterns of the patients after second-line treatment were examined.Results:After second-line treatment, the median OS and PFS were 19.4 and 12.0 months, respectively, and the overall objective response rate and disease control rate were 38.8% and 86.2%, respectively. Patients with lower NLR and PLR values exhibited significantly higher OS ( χ2 = 14.93, 11.60, P < 0.05) and PFS rates ( χ2=17.55, 8.95, P<0.05) compared to those with higher NLR and PLR values. Radiotherapy significantly improved the OS rates ( χ2 = 5.93, P < 0.05) of the patients, but produced insignificant effects on their PFS rates ( P > 0.05). Patients receiving whole-field radiotherapy exhibited superior OS and PFS rates compared to those treated with partial-field radiotherapy ( χ2 = 8.88, 4.93, P < 0.05). The intervention time of radiotherapy had no significant effects on the OS and PFS of the patients ( P > 0.05). The prognosis of the CR+ PR group was significantly better than that of the SD+ PD group ( χ2 = 8.97, 10.67, P > 0.05). The Cox multivariate analysis result identified the recurrence type, PLR, the number of immunotherapy cycles, local radiotherapy intervention, and recent efficacy as independent risk factors in the patients′OS ( HR = 2.67, 4.63, 0.39, 2.10, 3.35, P<0.05) and determined that NLR, PLR, the number of immunotherapy cycles, and recent efficacy were independent risk factors affecting the patients′ PFS ( HR = 1.79, 1.88, 0.54, 2.50, P<0.05). Among the patients, 38 (32.8%) experienced disease progression after second-line treatment, and 36 (31.0%) suffered from treatment-related adverse effects of grades ≥2, which were generally tolerable. Conclusions:Second-line treatment with ICIs combined with radiotherapy/chemotherapy can improve the prognosis of patients with LR/M ESCC. Further clinical exploration is warranted regarding the intervention timing and extent of radiotherapy.
