Tumor response and survival outcomes of salvage concurrent chemoradiotherapy with three-dimensional conformal radiotherapy and 5-fluorouracil/platinum-based chemotherapy for postoperative locoregional recurrence of esophageal squamous cell carcinoma

Abstract

Background Salvage concurrent chemoradiotherapy is effective against locoregional recurrence after curative resection of esophageal squamous cell carcinoma. However, there is no consensus on its application. We investigated the outcomes of salvage concurrent chemoradiotherapy (60 Gy in 30 fractions) with three-dimensional conformal radiotherapy and 5-fluorouracil/platinum-based chemotherapy. Methods We retrospectively investigated the outcomes and prognostic factors in 51 patients with esophageal squamous cell carcinoma treated with salvage concurrent chemoradiotherapy. Results The median follow-up was 17.5 (range, 2.8–116.1) months. The overall response, complete response, and partial response rates were 74.5%, 49.0%, and 25.5%, respectively. The median progression-free survival was 8.2 months; the 3-year progression-free survival rate was 22.9%. The median overall survival was 23.1 months; the 3-year overall survival rate was 40.7%. Overall survival was significantly longer in patients with a complete response than in those without (median overall survival: not reached vs. 15.3 months); 3-year overall survival rate: 62.5% vs. 20.3% (hazard ratio: 0.222; P < 0.001). Multivariate analysis showed that the independent prognostic factor for overall survival was < 25 mm longest diameter of metastatic lymph nodes (hazard ratio: 3.71). Conclusions Salvage concurrent chemoradiotherapy (60 Gy in 30 fractions) with three-dimensional conformal radiotherapy and 5-fluorouracil/platinum-based chemotherapy was an effective and safe treatment for locoregional recurrence after curative resection of esophageal squamous cell carcinoma, especially in those approaching a complete response. Additionally, a shorter longest diameter of metastatic lymph nodes may be associated with better long-term survival.

Individualized Treatment Decision Model for Inoperable Elderly Esophageal Squamous Cell Carcinoma based on Multi-Modal Data Fusion

“…Similarly, in the testing set, the low-risk group also displayed a higher median PFS than the high-risk group, albeit with a less pronounced difference. These ndings are in agreement with previous studies 27 . However, contrasting results have been reported in other studies where elderly ESCC patients, regardless of receiving CCRT or RT treatment, achieved longer median PFS 6 .…”

Individualized treatment decision model for inoperable elderly esophageal squamous cell carcinoma based on multi-modal data fusion

“…In the testing set, the low-risk group also displayed a higher median PFS rate than the high-risk group, although with a less pronounced difference. These findings align with those of previous studies [ 48 ]. However, contrasting results have been reported in other studies where elderly ESCC patients, regardless of receiving CCRT or RT treatment, achieved longer median PFS durations [ 11 ].…”

Retrospective study of the combination of TP and PF regimens with or without immune checkpoint inhibitors for the first-line treatment of locally advanced or advanced esophageal squamous cell carcinoma

“…13 OS and PFS were significantly longer in the KEYNOTE-590 study in the Pembrolizumab/placebo + TP group compared with the TP chemotherapy-alone group. 4,5 However, there was no significant difference between the two groups, with a 2.5-month and 1.6-month difference for OS and PFS, respectively. 13 The JUPITER-06 trial, a phase III clinical study conducted in the country with toripalimab/placebo + TP, also showed significantly longer OS and PFS in the combination group compared to the chemotherapy alone group, at 17.0 versus 11.0 months and at 5.7 versus 5.5 months, and the efficacy and safety of the combination therapy group was confirmed.…”

“…1,4 Standard first-line regimens for patients with advanced ESCC are predominantly platinum based, when used in combination with chemotherapy with fluorouracil (PF) or paclitaxel (TP), although their clinical benefit is relatively limited, and regimes of paclitaxel plus cisplatin (TP) are common in China, whereas fluorouracil-plus cisplatin (PF) regimens are more popular in other nations. 4–7…”

“…1,4 Standard first-line regimens for patients with advanced ESCC are predominantly platinum based, when used in combination with chemotherapy with fluorouracil (PF) or paclitaxel (TP), although their clinical benefit is relatively limited, and regimes of paclitaxel plus cisplatin (TP) are common in China, whereas fluorouracil-plus cisplatin (PF) regimens are more popular in other nations. [4][5][6][7] Targeted molecular drugs have shown promising benefit in a broad range of solid tumors, but their use in ECs is still quite limited, only in EACs with mutations in human epithelial growth factor receptor 2 or vascular endothelial growth factor, and there is no evidence-based targeted therapy that has significant benefit for ESCC. 4,8,9 Fortunately, in recent years, immune checkpoint inhibitors (ICIs) based on inhibitors of programmed cell death-1 or programmed cell deathligand 1 (PD-L1) have progressed in a broad range of solid tumors, including oesophageal cancer, melanoma, colorectal cancer, and some have been approved for first-line therapy.…”