The survival impact of upfront or sequential chemoradiotherapy in locally advanced esophageal squamous cell carcinoma.

Résumé

BACKGROUND: The treatment of locally advanced unresectable esophageal squamous cell carcinoma (ESCC) is a clinical challenge with limited therapeutic consensus. The immune checkpoint inhibitor (ICI)-based conversion therapies emerged as an option besides definitive chemoradiotherapy (DCRT). Especially for those returned to DCRT after unsuccessful conversion therapy (salvage), the clinical outcome remained overlooked when compared with upfront DCRT.METHODS: This study retrospectively analyzed the clinical data of patients with locally advanced ESCC who had received DCRT either as upfront or salvage therapy from 2018 to 2024. Overall survival (OS), event-free survival (EFS), progression-free survival (PFS) and objective remission rate (ORR) were assessed.RESULTS: Totally 848 patients from 3 medical centers were screened, and 91 patients were included. The overall objective remission rate (ORR) was achieved in 28 cases (68.29%) in the salvage group, higher than the upfront group (26.00%, P