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. 2022 Mar 30:12:824206.
doi: 10.3389/fonc.2022.824206. eCollection 2022.

Chemoradiotherapy Versus Chemotherapy Alone for Advanced Esophageal Squamous Cell Carcinoma: The Role of Definitive Radiotherapy for Primary Tumor in the Metastatic Setting

Li-Qing Li  1 , Qing-Guo Fu  1 , Wei-Dong Zhao  1 , Yu-Dan Wang  1 , Wan-Wan Meng  1 , Ting-Shi Su  1
Affiliations

Chemoradiotherapy Versus Chemotherapy Alone for Advanced Esophageal Squamous Cell Carcinoma: The Role of Definitive Radiotherapy for Primary Tumor in the Metastatic Setting

Li-Qing Li et al. Front Oncol. .

Abstract

Introduction: The role of definitive radiotherapy in advanced esophageal squamous cell carcinoma (ESCC), especially in the metastatic setting, remains unclear. Therefore, we aimed to investigate the efficacy of chemoradiotherapy (CRT) versus chemotherapy (CT) alone in these selected patients.

Methods: We retrospectively evaluated 194 newly diagnosed advanced ESCC who underwent definitive CRT or CT alone, including 97 patients with locally advanced and 97 patients with distant metastatic disease. Cumulative overall survival (OS) and progression-free survival (PFS) were evaluated with a log-rank test. Propensity score matching was used to simulate random allocation. In addition, we performed subgroup analysis in the locally advanced and metastatic disease.

Results: After matching, 63 well-paired patients were selected. The adjusted median OS (12.5 vs. 7.6 months, p = 0.002) and PFS (9.0 vs. 4.8 months, p = 0.0025) in the CRT group were superior to that in the CT-alone group. Further subgroup analysis revealed that CRT conferred survival benefits to both locally advanced and metastatic cohorts. For patients with distant metastasis, median OS (12.9 vs. 9.3 months, p = 0.029) and PFS (9.9 vs. 4.0 months, p =0.0032) in the CRT group were superior to that in the CT-alone group. In a multivariate Cox regression analysis of the entire cohort, additional definitive radiotherapy was independently associated with better OS (p = 0.041) and PFS (p = 0.007).

Conclusions: In both locally advanced and metastatic ESCC, additional definitive-dose radiotherapy was associated with improved clinical outcomes. Therefore, more consideration should be given to its application in the metastatic setting.

Keywords: advanced; chemoradiotherapy; definitive radiotherapy; esophageal squamous cell carcinoma; metastatic; survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curves of survival in patients with advanced ESCC treated with CRT and CT before PSM: (A) overall survival before PSM; (B) progression-free survival before PSM.
Figure 2
Figure 2
Kaplan–Meier curves of survival in patients with advanced ESCC treated with CRT and CT after PSM: (A) overall survival after PSM; (B) progression-free survival after PSM.
Figure 3
Figure 3
Kaplan–Meier curves of survival in patients with locally advanced ESCC treated with CRT and CT: (A) overall survival; (B) progression-free survival.
Figure 4
Figure 4
Kaplan–Meier curves of survival in patients with metastatic ESCC treated with CRT and CT: (A) overall survival; (B) progression-free survival.
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