Objective:

To explore the efficacy and safety of radiotherapy combined with immunotherapy-based regimens in elderly patients (≥70 years) with esophageal squamous cell carcinoma (ESCC), using the Cumulative Illness Rating Scale--Geriatric (CIRS-G) for stratification. This study is exploratory due to the modest sample size.

Key Findings:

• RIT ± CT regimen associated with reduced mortality risk compared to RT (HR = 0.341, 95% CI: 0.130–0.896, P = 0.029).
• PSM confirmed survival advantage for RIT ± CT (OS: HR = 0.42, 95% CI: [insert CI], P = 0.028).
• Patients with medium CIRS-G burden (scores 4–6) showed the most significant OS benefit.

Interpretation:

The integration of immunotherapy into radiotherapy regimens is associated with improved survival in elderly ESCC patients, with manageable safety profiles. CIRS-G may help identify optimal candidates for treatment. These findings require validation in larger studies.

Limitations:

• Exploratory nature and modest sample size limit definitive conclusions.
• Independent contribution of immunotherapy alone cannot be determined.

Conclusion:

The study suggests that multimodal treatment strategies involving immunotherapy and radiotherapy may enhance survival in elderly ESCC patients, warranting further validation in larger studies.