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Clinical outcomes and toxicities of locally advanced esophageal squamous cell carcinoma patients treated with early thoracic radiation therapy after induction chemotherapy

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International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Objective

The purpose of this study was to compare the clinical outcomes and toxicities between induction chemotherapy (IC) + chemo-radiotherapy (CRT) and CRT alone in patients with locally advanced esophageal squamous cell carcinoma (ESCC), to explore the appropriate thoracic radiotherapy (TRT) timing after IC and to identify prognostic factors.

Methods

450 ESCC patients were included from September 2011 to December 2020, 238 of whom received IC/CRT. Propensity score matching was performed to balance potential confounders between the two groups. Multivariate Cox regression analysis was used to identify the independent prognostic factors.

Results

Patients who received IC/CRT experienced improved overall survival (OS) (38.5 vs. 28.8 months) and progression-free survival (PFS) (41.0 vs. 22.0 months) before matching, with similar results after matching. In the IC/CRT group, early TRT had more favorable survival than late TRT both matching before and after. In subgroup analysis, early TRT combination concurrent chemotherapy had better OS and PFS than late TRT combination concurrent chemotherapy. In addition, early TRT had better survival benefits regardless of the N stage. Notably, the IC/CRT group and early TRT group had manageable toxicities reaction compared with CRT alone group and the late TRT group. The nomogram was developed to predict the OS and PFS based on multivariate analysis results. The C-index was 0.743 and 0.722, respectively.

Conclusion

IC/CRT and early TRT could yield satisfactory clinical outcomes and controllable toxicities in locally advanced ESCC. The IC plus early concurrent CRT might be a promising treatment strategy for improving further survival in ESCC.

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Availability of data and materials

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

EC:

Esophageal cancer

EAC:

Esophageal adenocarcinoma

ESCC:

Esophageal squamous cell carcinoma

dCRT:

Definitively chemoradiotherapy

OS:

Overall survival

IC/CRT:

Induction chemotherapy before chemoradiotherapy

CRT:

Chemoradiotherapy

TRT:

Thoracic radiotherapy

EUS:

Endoscopic ultrasonography

CT:

Computed tomography

PET/CT:

Positron emission tomography

TNM:

Tumor node metastasis

GTV:

Gross tumor volume

CTV:

Clinical tumor volume

PTV:

Planning tumor volume

CFRT:

Convention fractionate radiotherapy

PFS:

Progression-free survival

PSM:

Propensity score matching

BMI:

Body mass index

CCRT:

Concurrent chemoradiotherapy

T:

Tumor

N:

Nodes

IPTW:

The inverse probability of treatment weighting

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Acknowledgements

In the protocol design, data collection and analysis, and manuscript writing, we received strong support from clinical and technical colleagues. Their support and helps should be appreciated.

Funding

This work was supported by the National Clinical Key Specialty Construction Program, Fujian provincial Clinical Research Center for Cancer Radiotherapy and Immunotherapy (2020Y2012), and Fujian Science and Technology Innovation Joint Fund Project (2018Y9063).

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Author notes

  1. Jiancheng Li and Jinhuo Lai contributed equally as corresponding authors to this manuscript.

Authors and Affiliations

  1. Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China

    Jianjian Qiu, Hancui Lin, Yilin Yu, Dongmei Ke, Hui Li, Hongying Zheng, Qunhao Zheng, Zhiping Wang, Mingqiang Lin, Jun Yang, Lingyun Liu, Mengyan Zhang, Tianxiu Liu, Yahua Wu & Jiancheng Li

  2. Fujian Medical University Union Hospital, Fuzhou, 350001, China

    Jinhuo Lai

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Contributions

JCL, JHL and JJQ designed this study. JJQ, HCL, DMK, YLY, HL, HYZ, LYL, and QHZ contributed to data collection. MQL, JY, MYZ, and ZPW analyzed the data. JCL and JHL supervised the study. JJQ, HCL, YHW, and TXL wrote the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Jiancheng Li or Jinhuo Lai.

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Conflict of interest

The authors have no conflict of interest.

Ethics approval and consent to participate

This study was approved by the ethics committee of Fujian Medical University Cancer Hospital and conducted following the declaration of Helsinki principles and its amendment. All authors read the final manuscript and approved it for publication.

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All patients had signed written informed consent before treatment.

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Qiu, J., Lin, H., Yu, Y. et al. Clinical outcomes and toxicities of locally advanced esophageal squamous cell carcinoma patients treated with early thoracic radiation therapy after induction chemotherapy. Int J Clin Oncol 28, 550–564 (2023). https://doi.org/10.1007/s10147-023-02299-w

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