First-line induction or consolidation chemotherapy combined with concurrent chemoradiotherapy for esophageal squamous cell carcinoma.

Background: The RTOG 85-01 trial established that definitive concurrent chemoradiotherapy (CCRT) is the standard treatment for inoperable, locally advanced esophageal carcinoma, as well as for patients who decline surgery. The present study aims to compare the impact of three treatment modalities, CCRT, induction chemotherapy (ICT) followed by CCRT (ICT + CCRT), and CCRT followed by consolidation chemotherapy (CCT) (CCRT + CCT), on the survival of patients with inoperable esophageal squamous cell carcinoma (ESCC).

Methods: This retrospective analysis was conducted with 391 patients with ESCC who underwent radical CCRT with induction or CCT or CCRT only from January 2016 to October 2020 at the Fourth Hospital of Hebei Medical University in Shijiazhuang, Hebei province, China. Propensity score matching (PSM) analyses were performed. The primary outcome measure was efficacy included overall survival (OS) and progression-free survival (PFS). The final follow-up date ended on 31 May 2024.

Results: It showed a significantly better survival curve for OS in the CCRT + CCT group than the CCRT group (P=0.02, χ=5.503). It showed a significantly better survival curve for PFS in the CCRT + CCT group than the CCRT group (P=0.002, χ=9.788). It showed a significantly better survival curve for OS in the CCRT + CCT group than the ICT + CCRT group (P=0.046, χ=3.986). It showed a significantly better survival curve for PFS in the CCRT + CCT group than the ICT + CCRT group (P=0.01, χ=6.610). No significant differences were showed in treatment-related adverse events. Lesion length, N-staging, and combination of radiotherapy and chemotherapy were the independent prognostic factors for OS and PFS.

Conclusions: For inoperable ESCC patients, CCRT + CCT showed the best OS and PFS rates than ICT + CCRT and CCRT. There were no significant differences in treatment-related adverse events. Lesion length, N-staging, and combination of radiotherapy and chemotherapy were the independent prognostic factors for OS and PFS.