Clinical Report: Effect of Initial vs Sequential Chemoradiotherapy on Survival

Overview

This study demonstrates that salvage definitive chemoradiotherapy (DCRT) significantly improves overall survival (OS) in patients with locally advanced unresectable esophageal squamous cell carcinoma (ESCC) compared to upfront DCRT. The findings suggest a potential shift in treatment paradigms for this patient population.

Background

Locally advanced unresectable ESCC poses significant treatment challenges, with limited options leading to poor survival outcomes. The standard treatment has been definitive chemoradiotherapy (DCRT), but emerging therapies, including immune checkpoint inhibitors, have created new avenues for treatment. Understanding the efficacy of salvage DCRT after failed conversion therapy is crucial for optimizing patient management.

Data Highlights

Key Findings

• The salvage DCRT group had a median OS of 42.2 months compared to 15.9 months in the upfront group (HR 0.39, P = 0.001).
• 1-year OS rates were 95.1% for salvage vs 56.9% for upfront DCRT.
• 2-year OS rates were 68.8% for salvage vs 36.6% for upfront DCRT.
• The ORR was significantly higher in the salvage group (68.29%) compared to the upfront group (26.00%, P < 0.001).
• PFS was 20.3 months for the salvage group versus 6.4 months for the upfront group (HR 0.36, P = 0.001).

Clinical Implications

The findings support the use of salvage DCRT as a viable treatment option for patients with locally advanced unresectable ESCC who have failed conversion therapy. Clinicians should consider this strategy to enhance survival outcomes in this challenging patient population.

Conclusion

Salvage DCRT significantly improves survival outcomes compared to upfront DCRT in patients with locally advanced unresectable ESCC, warranting further investigation through prospective randomized trials.

References

1. Eyck et al, Journal of Clinical Oncology, 2021 -- Ten-Year Outcomes With Neoadjuvant Chemoradiotherapy Plus Surgery vs Surgery Alone for Esophageal Cancer
2. ASCO Post, 2011 -- Improved Survival with Concurrent Chemotherapy plus Radiotherapy for Patients with Stage III Non–Small Cell Lung Cancer
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4. NCCN Guidelines for Esophageal Cancer 2025
5. JAMA Network, 2021 -- Chemoradiotherapy of Locally Advanced Esophageal Cancer: Long-term Follow-up of a Prospective Randomized Trial (RTOG 85-01)
6. the asco post — Perioperative Chemotherapy vs Preoperative Chemoradiotherapy in Resectable Locally Advanced Esophageal Carcinoma
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8. NCCN Guidelines for Esophageal Cancer 2025 | PDF | Esophageal Cancer | Cancer
9. Chemoradiotherapy of Locally Advanced Esophageal Cancer: Long-term Follow-up of a Prospective Randomized Trial (RTOG 85-01) | Clinical Pharmacy and Pharmacology | JAMA | JAMA Network