Clinical Scorecard: The Effect of Initial Versus Sequential Chemoradiotherapy on Survival in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma

At a Glance

Key Highlights

• Salvage DCRT showed significantly improved overall survival (OS) compared to upfront DCRT.
• 1-year OS rates: 95.1% (salvage) vs. 56.9% (upfront).
• 2-year OS rates: 68.8% (salvage) vs. 36.6% (upfront).
• Objective remission rate (ORR) was higher in the salvage group (68.29%) than in the upfront group (26.00%).
• Median OS for the entire cohort was 24.6 months.

Guideline-Based Recommendations

Diagnosis

• Histological confirmation of ESCC is required.
• Clinical evaluation of tumor stage (cT2–4 N0/N + M0 or M1).

Management

• DCRT is the standard first-line treatment for locally advanced unresectable ESCC.
• Consider ICI-based conversion therapy prior to DCRT.

Monitoring & Follow-up

• Assess overall survival (OS), event-free survival (EFS), progression-free survival (PFS), and objective remission rate (ORR).

Risks

• Potential adverse effects from prior ICI therapy on subsequent DCRT efficacy.

Patient & Prescribing Data

Patients with unresectable locally advanced ESCC treated from January 2018 to May 2024.

Combination of ICIs with platinum-based chemotherapy followed by DCRT shows promise for improved outcomes.

Clinical Best Practices

• Utilize a multidisciplinary treatment approach for managing locally advanced ESCC.
• Consider salvage DCRT for patients who do not respond to initial conversion therapy.

References

• Study on ESCC treatment outcomes