Simultaneous integrated boost radiation therapy may improve survival rates for esophageal squamous cell carcinoma

1. For patients aged 70 years and older with esophageal squamous cell carcinoma (ESCC), the combination of simultaneous integrated boost radiation therapy (SIB-RT) technique with concurrent and consolidated oral S-1 chemotherapy resulted in improved overall survival (OS) and progression-free survival (PFS).

Evidence Rating Level: 1 (Excellent)

Patients aged 70 years and above constitute a significant proportion (30% to 40%) of individuals diagnosed with ESCC worldwide. The conventional treatment for inoperable ESCC involves concurrent double-agent IV chemotherapy and radiotherapy, which is not tolerated well in patients with advanced age and comorbidities. Advanced radiation techniques, namely SIB-RT, have shown several advantages over traditional techniques including shortened overall treatment course. S-1, an orally administered chemotherapeutic drug, has also shown promising effectiveness and safety in patients with digestive system tumors. Hence, this phase II randomized clinical trial aimed to evaluate the efficacy and toxicity of SIB-RT with concurrent S-1 chemotherapy to treat inoperable ESCC in patients aged 70 years and older. 330 eligible patients (median [IQR] age, 75.5 [72-79] years; 220 [66.7%] male patients) were recruited from 10 centers in China between March 2017 and April 2020. Patients were randomized 1:1 to receive S-1–based definitive SIB-RT followed by consolidated chemotherapy (CRTCT group) or SIB-RT alone (RT group). OS was improved in the CRTCT group compared with the RT group at 1 year (72.2% vs 62.3%), 2 years (55.7% vs 43.8%), and 3 years (46.2% vs 33.9%; log-rank P = .02). Similarly the CRTC group demonstrated improved PFS compared with the RT group at 1 year (60.8% vs 49.3%), 2 years (45.4% vs. 37.0%) and 3 years (37.3% vs 27.9%; log-rank P = .04). Overall, compared with SIB-RT alone, SIB-RT with oral S-1 chemotherapy demonstrated improved survival outcomes without additional treatment-related toxic side-effects for patients aged 70 years and older with inoperable ESCC and should therefore be considered as a definitive treatment option. 

Click to read the study in JAMA Network Open

Image: PD

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