Weifang Hospital of Traditional Chinese Medicine, 666 Weizhou Road, Weifang, 261000, Shandong, China.
Shandong University of Traditional Chinese Medicine, Jinan, 250000, Shandong, China.
J Cancer Res Clin Oncol. 2023 Dec;149(20):18253-18270. doi: 10.1007/s00432-023-05499-z. Epub 2023 Nov 20.
Immunotherapy has shown promise in the treatment of esophageal cancer, but using it alone only benefits a small number of patients. Most patients either do not have a significant response or develop secondary drug resistance. The combination of radiotherapy and immunotherapy appears to be a promising approach to treating esophageal cancer.
We reviewed milestone clinical trials of radiotherapy combined with immunotherapy for esophageal cancer. We then discussed potential biomarkers for radiotherapy combined with immunotherapy, including programmed cell death-ligand 1 (PD-L1) status, tumor mutation burden (TMB), tumor-infiltrating lymphocytes, ct-DNA, imaging biomarkers, and clinical factors. Furthermore, we emphasize the key mechanisms of radiation therapy-induced immune stimulation and immune suppression in order to propose strategies for overcoming immune resistance in radiation therapy (RT). Lastly, we discussed the emerging role of low-dose radiotherapy (LDRT) , which has become a promising approach to overcome the limitations of high-dose radiotherapy.
Radiotherapy can be considered a triggering factor for systemic anti-tumor immune response and, with the assistance of immunotherapy, can serve as a systemic treatment option and potentially become the standard treatment for cancer patients.
免疫疗法在食管癌治疗中显示出前景，但单独使用免疫疗法仅能使少数患者受益。大多数患者要么没有明显反应，要么产生继发耐药性。放疗和免疫疗法的联合似乎是治疗食管癌的一种有前途的方法。
我们回顾了食管癌放疗联合免疫治疗的里程碑式临床试验。然后，我们讨论了放疗联合免疫治疗的潜在生物标志物，包括程序性细胞死亡配体 1（PD-L1）状态、肿瘤突变负担（TMB）、肿瘤浸润淋巴细胞、ct-DNA、影像学生物标志物和临床因素。此外，我们强调了放疗诱导免疫刺激和免疫抑制的关键机制，以提出克服放疗免疫抵抗的策略。最后，我们讨论了低剂量放疗（LDRT）的新作用，它已成为克服高剂量放疗局限性的一种有前途的方法。
放疗可被视为全身抗肿瘤免疫反应的触发因素，在免疫疗法的辅助下，可作为全身治疗选择，并有可能成为癌症患者的标准治疗方法。
