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The effect of combined chemoradiotherapy versus chemotherapy alone on the survival of ⅣB stage esophageal squamous cell carcinoma
Li Shenglei1, Wang Kunlun1, Yang Hui1, Li Bingxu2, Li Yan1, Yuan Ling1
1Department of Radiation oncology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450003,China; 2Department of Radiation oncology, Anyang Cancer Hospital, Anyang 455001,China
AbstractObjective To investigate the survival benefit of radiotherapy on the basis of systemic treatment for stage ⅣB esophageal squamous cell carcinoma (ESCC). Methods Based on inclusion and exclusion criteria, we collected the treatment information of 298 patients with newly diagnosed stage ⅣB ESCC admitted to Affiliated Cancer Hospital of Zhengzhou University from January 2016 to February 2021. All patients were divided into two groups based on treatment: early radiotherapy intervention group (CRT group,n=197) and salvage radiotherapy intervention or no intervention group (CT group,n=101). Propensity score matching (PSM) was used to balance baseline characteristics between two groups. Kaplan‐Meier method was used to calculate the survival rate and log‐rank was used to test the difference. Cox model was used to analyze the multivariate prognosis. Results In the CRT and CT groups, the Objective response rate (ORR) and disease control rate (DCR) were 52.8% vs. 31.5%(P=0.006) and 98.9% vs. 85.4%(P=0.001) respectively, and the 1‐, 2‐ and 3‐year survival rates were 74.2% vs. 52.8%、31.5% vs. 10.1% and 15.7% vs. 2.2%, respectively. Median progression‐free survival (PFS) was 8.5 months (95%CI: 6.7‐10.3 months) vs. 4.4 months (95%CI: 3.5‐5.3 months)(P<0.001). Median overall survival (OS) were 17.1 months (95%CI: 14.9‐19.3 months) vs. 12.7 months (95%CI: 8.0‐17.4 months)(P<0.001). The difference of adverse reactions was mainly in hematology. Conclusions For newly diagnosed stage ⅣB patients with ESCC, radiotherapy should be combined with systemic therapy as early as possible. It yields longer PFS and OS, and effectively improves dysphagia. Adverse reactions are tolerated. Further validation is recommended in larger prospective studies.
Li Shenglei,Wang Kunlun,Yang Hui et al. The effect of combined chemoradiotherapy versus chemotherapy alone on the survival of ⅣB stage esophageal squamous cell carcinoma[J]. Chinese Journal of Radiation Oncology, 2022, 31(10): 884-890.
Li Shenglei,Wang Kunlun,Yang Hui et al. The effect of combined chemoradiotherapy versus chemotherapy alone on the survival of ⅣB stage esophageal squamous cell carcinoma[J]. Chinese Journal of Radiation Oncology, 2022, 31(10): 884-890.
[1] Zheng RS, Zhang SW, Zeng HM, et al. Cancer incidence and mortality in China, 2016[J]. JNCC, 2022, 2(1):1‐9. DOI: 10.1016/j.jncc.2022.02.002. [2] Ai D, Zhu H, Ren W, et al.Patterns of distant organ metastases in esophageal cancer: a population-based study[J]. J Thorac Dis, 2017,9(9):3023-3030. DOI: 10.21037/jtd.2017.08.72. [3] Quint LE, Hepburn LM, Francis IR, et al.Incidence and distribution of distant metastases from newly diagnosed esophageal carcinoma[J]. Cancer, 1995,76(7):1120-1125. DOI: 10.1002/1097-0142(19951001)76:7<1120::aid-cncr2820760 704>3.0.co;2-w. [4] Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)[J]. Eur J Cancer, 2009,45(2):228‐247. DOI: 10.1016/j. ejca. 2008.10.026. [5] Bown SG, Hawes R, Matthewson K, et al.Endoscopic laser palliation for advanced malignant dysphagia[J]. Gut, 1987,28(7):799-807. DOI: 10.1136/gut.28.7.799. [6] O'Rourke IC, Tiver K, Bull C, et al. Swallowing performance after radiation therapy for carcinoma of the esophagus[J]. Cancer, 1988,61(10):2022-2026. DOI: 10.1002/1097-0142(19880515)61:10<2022::aid-cncr2820611016>3.0.co;2-0. [7] 王雪锋, 曹峰, 景绍武, 等. 初诊ⅣB期胸段食管鳞癌综合放疗长期生存获益研究[J].中华放射肿瘤学杂志,2021,30(6):543-548. DOI: 10.3760/cma.j.cn113030-20200925-00483. Wang XF, Cao F, Jing SW, et al.Radiotherapy is beneficial for long-term survival of patients with stage ⅣB thoracic esophageal squamous cell carcinoma at initial diagnosis[J].Chin J Radiat Oncol,2021,30(6):543-548. DOI: 10.3760/cma.j.cn113030-20200925-00483. [8] Li T, Lv J, Li F, et al.Prospective randomized phase 2 study of concurrent chemoradiation therapy (CCRT) versus chemotherapy alone in stage IV esophageal squamous cell carcinoma (ESCC)[J]. Int J Radiat Oncol Biol Phys, 2016,96(2S):S1. DOI: 10.1016/j.ijrobp.2016.06.020. [9] Sun JM, Shen L, Shah MA, et al.Pembrolizumab plus chemotherapy versus chemotherapy alone for first-line treatment of advanced oesophageal cancer (KEYNOTE-590): a randomised, placebo-controlled, phase 3 study[J]. Lancet, 2021,398(10302):759-771. DOI: 10.1016/S0140-6736(21)01234-4. [10] Luo H, Lu J, Bai Y, et al.Effect of camrelizumab vs placebo added to chemotherapy on survival and progression-free survival in patients with advanced or metastatic esophageal squamous cell carcinoma: the ESCORT-1st randomized clinical trial[J]. JAMA, 2021,326(10):916-925. DOI: 10.1001/jama.2021.12836. [11] Doki Y, Ajani JA, Kato K, et al.Nivolumab combination therapy in advanced esophageal squamous-cell carcinoma[J]. N Engl J Med, 2022,386(5):449-462. DOI: 10.1056/NEJMoa2111380. [12] Kojima T, Muro K, Francois E, et al.Pembrolizumab versus chemotherapy as second‐line therapy for advanced esophageal cancer. phase Ⅲ KEYNOTE‐181 study[J].J Clin Oncol, 2019,37(4suppl):2.DOI: 10.1093/annonc/mdz154.011. [13] Kato K, Cho BC, Takahashi M, et al.Nivolumab versus chemotherapy in patients with advanced oesophageal squamous cell carcinoma refractory or intolerant to previous chemotherapy (ATTRACTION-3): a multicentre, randomised, open-label, phase 3 trial[J]. Lancet Oncol, 2019,20(11):1506-1517. DOI: 10.1016/S1470-2045(19)30626-6. [14] Huang J, Xu J, Chen Y, et al.Camrelizumab versus investigator's choice of chemotherapy as second-line therapy for advanced or metastatic oesophageal squamous cell carcinoma (ESCORT): a multicentre, randomised, open-label, phase 3 study[J]. Lancet Oncol, 2020,21(6):832-842. DOI: 10.1016/S1470-2045(20)30110-8. [15] Matsumura S, Wang B, Kawashima N, et al.Radiation-induced CXCL16 release by breast cancer cells attracts effector T cells[J]. J Immunol, 2008,181(5):3099-3107. DOI: 10.4049/jimmunol.181.5.3099. [16] Chakraborty M, Abrams SI, Camphausen K, et al.Irradiation of tumor cells up-regulates Fas and enhances CTL lytic activity and CTL adoptive immunotherapy[J]. J Immunol, 2003,170(12):6338-6347. DOI: 10.4049/jimmunol.170. 12.6338. [17] Illidge T, Lipowska‐Bhalla G, Cheadle E, et al. Radiation therapy induces an adaptive upregulation of PD‐L1 on tumor cells which may limit the efficacy of the anti‐tumor immune response but can be circumvented by anti‐PD‐L1[J]. Int J Radiat Oncol Biol Phys, 2014,90(1suppl):S776. DOI:10.1016/j.ijrobp.2014.05.2247. [18] Liu Y, Ren Z, Yuan L, et al.Paclitaxel plus cisplatin vs. 5-fluorouracil plus cisplatin as first-line treatment for patients with advanced squamous cell esophageal cancer[J]. Am J Cancer Res, 2016,6(10):2345-2350. [19] Adelstein DJ, Rice TW, Rybicki LA, et al.Does paclitaxel improve the chemoradiotherapy of locoregionally advanced esophageal cancer? A nonrandomized comparison with fluorouracil-based therapy[J]. J Clin Oncol, 2000,18(10):2032-2039. DOI: 10.1200/JCO.2000.18.10.2032.
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