ORIGINAL RESEARCH article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
This article is part of the Research TopicReal-World Clinical and Translational Research in Gastrointestinal CancersView all 24 articles
Preliminary Exploration of Radiotherapy Timing Following Induction Chemoimmunotherapy in Unresectable Locally Advanced Esophageal Squamous Cell Carcinoma: A Single-Center Retrospective Study
Provisionally accepted
- 1Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- 2Nanchong Central Hospital Affiliated to North Sichuan Medical College, Nanchong, China
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Objective: To evaluate the efficacy and safety of the sequential strategy involving induction chemoimmunotherapy followed by radiotherapy for locally advanced unresectable esophageal squamous cell carcinoma (ESCC), and to explore the optimal timing for radiotherapy intervention and the potential clinical benefits of subsequent consolidative immunotherapy. Method: This study retrospectively collected clinical data from treatment-naïve patients with unresectable T1-4N0-3M0 stage ESCC who underwent induction chemoimmunotherapy followed by radiotherapy at the Affiliated Hospital of North Sichuan Medical College between December 2021 and May 2024. Patients were stratified into two cohorts: the early radiotherapy cohort (early-RT, n=34), who initiated radiotherapy after completion of 1-2 cycles of induction chemoimmunotherapy, and the late radiotherapy cohort (late-RT, n=44), who initiated radiotherapy after completing 3-6 cycles of induction chemoimmunotherapy. The primary endpoints were progression-free survival (PFS) and overall survival (OS), with safety serving as the secondary endpoint. Result: With a cutoff date of May 31, 2025, the median follow-up duration was 25.9 months. In the overall population, the median PFS was 16.0 months (95% confidence interval [CI], 11.7-20.3) and the median OS was 25.0 months (95%CI, 21.49-28.51). PFS was significantly longer in the early-RT cohort than in the late-RT cohort(20.4 vs. 13.7 months; HR = 0.53; p = 0.032). No statistically significant difference in OS was observed between the two cohorts (26.6 vs. 24.8 months; p = 0.728). Subsequent consolidative immunotherapy significantly improved PFS (median not reached [NR] vs. 12.8 months; HR = 0.46; p = 0.011) and OS (NR vs. 24.1 months; HR = 0.43; p = 0.017). In terms of safety, most treatment-related adverse events (TRAEs) were grade 1 or 2 in severity and were manageable. The incidence of toxicities did not differ significantly between the early-RT and late-RT cohorts (p > 0.05). Conclusion: In patients with unresectable locally advanced ESCC, the combination of early radiotherapy intervention and subsequent consolidative immunotherapy may represent a potential
Keywords: Esophageal squamous cell carcinoma1, cancer immunotherapy2, chemotherapy3, radiotherapy4, timing of intervention5
Received: 11 Sep 2025; Accepted: 30 Nov 2025.
Copyright: © 2025 Zeng, Zhang, Xu, Zhang and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dai-Yuan Ma
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