| Wang Yufang,Liu Meirong.Preliminary analysis of chemoradiotherapy combined with immunotherapy in patients with recurrent or metastatic esophageal squamous cell carcinoma[J].Chinese Journal of Radiological Medicine and Protection,2024,44(9):749-757 |
| Preliminary analysis of chemoradiotherapy combined with immunotherapy in patients with recurrent or metastatic esophageal squamous cell carcinoma |
| Received:January 08, 2024 |
| DOI：10.3760/cma.j.cn112271-20240108-00007 |
| KeyWords:Esophageal squamous cell carcinoma Second-line treatment Immune checkpoint inhibitors Radiotherapy/chemotherapy Prognosis |
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| 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. |
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