Preliminary analysis of chemoradiotherapy combined with immunotherapy in patients with recurrent or metastatic esophageal squamous cell carcinoma
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(x2=14.93,11.60,P＜0.05)and PFS rates(x2=17.55,8.95,P＜0.05)compared to those with higher NLR and PLR values.Radiotherapy significantly improved the OS rates(x2=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(x2=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(x2=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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