Effectiveness of Chemotherapy With/Without Radiotherapy for Locally Advanced Esophageal Squamous Cell Carcinoma: A...

Area of Science:

• Oncology
• Esophageal Cancer Research
• Radiotherapy and Chemotherapy Efficacy

Background:

• Neoadjuvant radiotherapy's role in locally advanced esophageal squamous cell carcinoma (LA-ESCC) alongside preoperative systemic treatment is debated.
• Optimal neoadjuvant strategies for LA-ESCC require further investigation to guide clinical practice.

Purpose of the Study:

• To compare the overall survival of LA-ESCC patients receiving neoadjuvant concurrent chemoradiotherapy (nCCRT) versus neoadjuvant chemotherapy (nCT).
• To evaluate the impact of nCCRT versus nCT on other relevant oncological outcomes in LA-ESCC.

Main Methods:

• Population-based cohort study using Taiwan Cancer Registry data (2011-2022).
• Target trial emulation (TTE) framework with propensity score weighting (PSW) to control for confounding.
• Comparison of hazard ratios for death between nCCRT and nCT groups.

Main Results:

• The primary analysis included 2069 LA-ESCC patients.
• No significant difference in overall survival was observed between nCCRT and nCT groups (PSW-adjusted HR: 0.82; p=0.62).
• Pathological complete response rate was higher in the nCCRT group, but overall survival and other endpoints showed no significant difference.

Conclusions:

• Neoadjuvant concurrent chemoradiotherapy (nCCRT) does not offer a significant survival advantage over neoadjuvant chemotherapy (nCT) for LA-ESCC patients.
• Findings suggest that current neoadjuvant treatment strategies may need re-evaluation for LA-ESCC patients.