Long-term results of definitive chemoradiotherapy for unresectable locally advanced esophageal squamous cell carcinoma

Abstract

Purpose The present study aimed to evaluate the long-term results of definitive chemoradiotherapy (CRT) for unresectable locally advanced esophageal squamous cell carcinoma (LA-ESCC). Materials and methods We analyzed eighty patients with unresectable LA-ESCC, who underwent definitive CRT between 2001 and 2014. The 5-year overall survival (OS), cause-specific survival (CSS), and progression-free survival (PFS) rates were calculated, and we investigated the prognostic factors and adverse events. Results The median age was 66 years (range, 41–83 years). Histologically, all patients had squamous cell carcinoma. The most common tumor site was the middle thoracic esophagus in 43 (54%) patients. According to the eighth edition of the Union for International Cancer Control TNM classification, sixty-six patients (83%) had T4 disease, 59 (74%) had regional lymph node (LN) metastases, and 35 (44%) had distant LN metastases beyond the regional LN (M1 LYM) disease. Forty-five (56%) and 35 (44%) patients belong to clinical stages IVA and IVB, respectively. The median follow-up period for survivors was 86 months. The 5-year OS, CSS, and PFS rates were 20.2%, 25.7%, and 18.4%, respectively. On univariate analysis, only the performance status score was significantly associated with better overall survival (p = 0.026). Grade 3 or higher late adverse events were observed in 12 (15%) patients, and these included cardiopulmonary adverse events in 6 (8%) patients. Treatment-related death occurred in 3 (4%) patients. Conclusion We showed the long-term results of definitive CRT for unresectable LA-ESCC. The survivals are still poor and new treatment strategies need to be developed.

Durvalumab and tremelimumab with definitive chemoradiotherapy for locally advanced esophageal squamous cell carcinoma

“…In addition, the survival outcome of our historical control group was much better than the outcomes reported in other countries or institutes. 3,4,17,22 Therefore, the improved survival outcome of the study population observed in our comparative analysis suggests the reliable, promising efficacy of our study regimen and encourages attempts to reproduce these results in larger studies.…”

“…On the basis of prior reports, the clinical outcomes after definitive CCRT for esophageal cancer treatment are disappointing. However, such clinical outcomes varied according to institution, radiation dose, tumor site, and disease status 3,4,17‐21 . Therefore, we could not rule out the possibility that the promising outcomes in our study arm were affected by some biases, especially the specialized care performed in our single tertiary cancer center.…”

“…However, such clinical outcomes varied according to institution, radiation dose, tumor site, and disease status. 3,4,[17][18][19][20][21] Therefore, we could not rule out the possibility that the promising outcomes in our study arm were affected by some biases, especially the specialized care performed in our single tertiary cancer center. To compensate for such potential biases, we compared the treatment efficacy in the study group with that in the propensity score-matched historical control group.…”

“…The standard therapy for inoperable, locally advanced esophageal cancer is definitive concurrent chemoradiotherapy (CCRT). However, clinical outcomes after CCRT are not satisfactory, with 5‐year survival rates of approximately 20% 3,4 . Several PD‐1 or PD‐L1 inhibitors have demonstrated clinical roles in the treatment of ESCC.…”

“…However, clinical outcomes after CCRT are not satisfactory, with 5-year survival rates of approximately 20%. 3,4 Several PD-1 or PD-L1 inhibitors have demonstrated clinical roles in the treatment of ESCC. Pembrolizumab and nivolumab have demonstrated efficacy as monotherapy drugs compared with second-line chemotherapeutics for the treatment of metastatic ESCC.…”