Postoperative radiotherapy versus systemic therapy alone for locally advanced esophageal squamous cell carcinoma following neoadjuvant chemoimmunotherapy
Abstract
ObjectiveNeoadjuvant chemoimmunotherapy (nICT) followed by radical esophagectomy is increasingly used for locally advanced esophageal squamous cell carcinoma (LA-ESCC), but the incremental value of postoperative radiotherapy (PORT) in patients who also receive postoperative systemic therapy remains uncertain. This study evaluated survival outcomes, recurrence patterns, and treatment-related toxicity associated with adding PORT after nICT and surgery.MethodsWe retrospectively reviewed 336 patients with LA-ESCC who underwent nICT followed by R0 esophagectomy between February 2021 and November 2024. Postoperatively, 93 patients received systemic therapy plus PORT, whereas 243 received systemic therapy alone. Propensity score matching at a 1:1 ratio was performed to balance baseline clinicopathological characteristics, yielding 71 patients in each group. Disease-free survival (DFS), overall survival (OS), recurrence patterns, and treatment-related adverse events were analyzed.ResultsAfter PSM, 142 patients (71 per group) were analyzed. The PORT group demonstrated significantly improved 2-year OS (91.0% vs. 75.5%; HR = 0.409, 95% CI: 0.181-0.925, P = 0.026) and 2-year DFS (74.2% vs. 50.1%; HR = 0.525, 95% CI: 0.303-0.911, P = 0.018) compared to the systemic therapy group. Patients with ypStage III-IV and ypN+ derived the most significant survival benefits. PORT reduced the locoregional recurrence rate from 48.1% to 32.1%, shifting the primary failure mode to distant metastasis (46.4%). Grade ≥3 treatment-related adverse events occurred in 18.3% of PORT patients (primarily hematologic), with grade 3 radiation esophagitis occurring in only 1.1%.ConclusionFor LA-ESCC patients treated with nICT and surgery, adding PORT to postoperative systemic therapy improves survival and optimizes recurrence patterns with acceptable toxicity. It represents a promising intensification strategy for high-risk patients.
Related
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- Efficacy comparison of neoadjuvant chemotherapy, chemoradiotherapy, and chemoimmunotherapy in resectable esophageal squamous cell carcinoma: short- and long-term outcomes from a propensity score-matched analysis
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- Prognostic significance of lymph node staging in esophageal squamous cell carcinoma after neoadjuvant chemoimmunotherapy
BibTeX
@article{yuan2026postoperative,
title = {{Postoperative radiotherapy versus systemic therapy alone for locally advanced esophageal squamous cell carcinoma following neoadjuvant chemoimmunotherapy}},
author = {Zongqian Yuan and Junfeng Zhao and Chunhui Li and Ying Li and Yingrui Bai and Ruidan Zhang and Cong Liu and Chengxin Liu},
journal = {Frontiers in Oncology},
year = {2026},
month = nov,
doi = {10.3389/fonc.2026.1978264},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1978264},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Postoperative radiotherapy versus systemic therapy alone for locally advanced esophageal squamous cell carcinoma following neoadjuvant chemoimmunotherapy
AU - Zongqian Yuan
AU - Junfeng Zhao
AU - Chunhui Li
AU - Ying Li
AU - Yingrui Bai
AU - Ruidan Zhang
AU - Cong Liu
AU - Chengxin Liu
PY - 2026
DA - 2026/11/09
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1978264
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1978264
AB - ObjectiveNeoadjuvant chemoimmunotherapy (nICT) followed by radical esophagectomy is increasingly used for locally advanced esophageal squamous cell carcinoma (LA-ESCC), but the incremental value of postoperative radiotherapy (PORT) in patients who also receive postoperative systemic therapy remains uncertain. This study evaluated survival outcomes, recurrence patterns, and treatment-related toxicity associated with adding PORT after nICT and surgery.MethodsWe retrospectively reviewed 336 patients with LA-ESCC who underwent nICT followed by R0 esophagectomy between February 2021 and November 2024. Postoperatively, 93 patients received systemic therapy plus PORT, whereas 243 received systemic therapy alone. Propensity score matching at a 1:1 ratio was performed to balance baseline clinicopathological characteristics, yielding 71 patients in each group. Disease-free survival (DFS), overall survival (OS), recurrence patterns, and treatment-related adverse events were analyzed.ResultsAfter PSM, 142 patients (71 per group) were analyzed. The PORT group demonstrated significantly improved 2-year OS (91.0% vs. 75.5%; HR = 0.409, 95% CI: 0.181-0.925, P = 0.026) and 2-year DFS (74.2% vs. 50.1%; HR = 0.525, 95% CI: 0.303-0.911, P = 0.018) compared to the systemic therapy group. Patients with ypStage III-IV and ypN+ derived the most significant survival benefits. PORT reduced the locoregional recurrence rate from 48.1% to 32.1%, shifting the primary failure mode to distant metastasis (46.4%). Grade ≥3 treatment-related adverse events occurred in 18.3% of PORT patients (primarily hematologic), with grade 3 radiation esophagitis occurring in only 1.1%.ConclusionFor LA-ESCC patients treated with nICT and surgery, adding PORT to postoperative systemic therapy improves survival and optimizes recurrence patterns with acceptable toxicity. It represents a promising intensification strategy for high-risk patients.
SN - 2234-943X
ER -