优化局部晚期食管鳞状细胞癌的新辅助放疗:关于同步或序贯免疫检查点抑制剂作用的综合综述

Optimizing neoadjuvant radiotherapy for locally advanced esophageal squamous cell carcinoma: a comprehensive review on the role of concomitant or sequential immune checkpoint inhibitors.

作者信息

Ghalehtaki Reza, Amini Arya, Abyaneh Romina

机构信息

Department of Radiation Oncology, Cancer Institute, IKHC, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Radiation Oncology Research Center, Cancer Research Institute, IKHC, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Esophagus. 2025 Jan;22(1):5-18. doi: 10.1007/s10388-024-01097-1. Epub 2024 Nov 19.

Abstract

Esophageal squamous cell carcinoma (ESCC) is a prevalent form of esophageal cancer with a poor prognosis despite advances in treatment. Combining immune checkpoint inhibitors (ICIs) with radiotherapy (RT) or chemoradiotherapy (CRT) has shown potential in enhancing treatment efficacy. We conducted a comprehensive review of clinical trials published between 2019 and 2024, sourced from PubMed, Scopus, and Embase databases. Studies included were prospective phase II trials that evaluated the combination of ICIs with neoadjuvant chemoradiotherapy (nCRT) in resectable locally advanced ESCC. Ten trials met the inclusion criteria. The review highlights various approaches in combining ICIs with CRT, including concurrent, induction, and consolidation therapy. Among the included trials, a significant proportion focused on concurrently administering ICIs with CRT, showing promising outcomes with high pathological complete response rates (pCR) and manageable toxicities. However, further research is needed to validate the efficacy of induction and consolidation therapies and determine optimal treatment protocols. The combination of ICIs and nCRT can potentially improve treatment responses and outcomes for patients with locally advanced ESCC. Despite recent encouraging findings, most trials were single-arm with small sample sizes, indicating the need for larger studies with longer follow-ups to assess survival outcomes comprehensively.

摘要

食管鳞状细胞癌(ESCC)是食管癌的一种常见形式,尽管治疗取得了进展,但其预后仍然很差。将免疫检查点抑制剂(ICI)与放射治疗(RT)或放化疗(CRT)联合使用已显示出提高治疗效果的潜力。我们对2019年至2024年间发表的临床试验进行了全面综述,这些试验来自PubMed、Scopus和Embase数据库。纳入的研究为前瞻性II期试验,评估了ICI与新辅助放化疗(nCRT)联合用于可切除的局部晚期ESCC的情况。十项试验符合纳入标准。该综述强调了将ICI与CRT联合使用的各种方法,包括同步、诱导和巩固治疗。在所纳入的试验中,很大一部分集中于将ICI与CRT同步给药,显示出有前景的结果,病理完全缓解率(pCR)高且毒性可控。然而,需要进一步研究来验证诱导和巩固治疗的疗效,并确定最佳治疗方案。ICI与nCRT联合使用有可能改善局部晚期ESCC患者的治疗反应和结局。尽管最近有令人鼓舞的发现,但大多数试验为单臂试验且样本量小,这表明需要进行更大规模、随访时间更长的研究来全面评估生存结局。

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