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Original Article
- Concurrent Chemoradiotherapy with or without Induction Chemoimmunotherapy in Unresectable Esophageal Squamous Cell Carcinoma: A Multicenter Real-World Study
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Biqi Chen1,2
, Peiying Cen1,2, Qi Cheng4,5, Tiejun Wang6, Zimeng Li1,2, Chen Yi1,2, Xingyuan Cheng1,2, Dongmei Chi2,7, Shiliang Liu1,2, Yujia Zhu1,2, Hao Zhang8, Mian Xi1,2,3, Baoqing Chen1,2,3, Yujin Xu4,5
, Qiaoqiao Li1,2
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DOI: https://doi.org/10.4143/crt.2025.1224 [Accepted]
Published online: April 28, 2026
This article has been accepted for publication following full peer review and is provided as an unedited Accepted Article to allow early access to its findings. It has not yet undergone copyediting, typesetting, pagination, or proofreading, and the final Version of Record may differ from this version.
1Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
2Guangdong Esophageal Cancer Research Institute, Guangzhou, China
3United Laboratory of Frontier Radiotherapy Technology of Sun Yat-sen University & Chinese Academy of Sciences Ion Medical Technology Co., Ltd, Guangzhou, China
4Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, China
5Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
6Breast cancer center, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, National Key Clinical Specialty Construction Discipline, Hubei Provincial Clinical Research Center for Breast Cancer, Wuhan Clinical Research Center for Breast Cancer. Wuhan, China
7Department of Anesthesiology, Sun Yat-sen University Cancer Center, Guangzhou, China
8Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
2Guangdong Esophageal Cancer Research Institute, Guangzhou, China
3United Laboratory of Frontier Radiotherapy Technology of Sun Yat-sen University & Chinese Academy of Sciences Ion Medical Technology Co., Ltd, Guangzhou, China
4Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, China
5Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
6Breast cancer center, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, National Key Clinical Specialty Construction Discipline, Hubei Provincial Clinical Research Center for Breast Cancer, Wuhan Clinical Research Center for Breast Cancer. Wuhan, China
7Department of Anesthesiology, Sun Yat-sen University Cancer Center, Guangzhou, China
8Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Corresponding author:
Yujin Xu
Tel: 86-20-87343492
Email: liqq@sysucc.org.cn
Qiaoqiao Li
Tel: 86-0571-88128178
Email: xuyj@zjcc.org.cn
- Biqi Chen, Peiying Cen and Qi Cheng contributed equally to this work.
Received: 7 November 2025 • Accepted: 27 April 2026
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Abstract
Purpose
This study aimed to compare the efficacy and safety of concurrent chemoradiotherapy (CCRT) with or without induction chemoimmunotherapy (CI) in unresectable esophageal squamous cell carcinoma (ESCC).
Materials and Methods
The study included patients with unresectable ESCC who received CCRT with or without induction CI at three cancer centers. Patients receiving concurrent immunotherapy were excluded. Propensity score matching (PSM) balanced baseline characteristics between groups.
Results
A total of 519 patients were included. After PSM, 183 patients per group were selected. Induction CI significantly improved OS and PFS compared to CCRT alone, consistently. The median OS for CCRT and induction CI groups were 29.9 months (95% CI: 18.8-41.0) and not reached (HR: 0.57, 95% CI: 0.42-0.77, p < 0.001). The median PFS was 17.6 months (IQR: 13.7-21.4) versus 30.6 months (IQR: 17.3-43.8) (HR: 0.66, 95% CI: 0.51-0.86, p = 0.002). Responders to the induction CI had significantly better OS (HR: 0.22, 95%CI: 0.14-0.36, p < 0.001) than nonresponders. Subgroup analysis showed radiation dose escalation or consolidation immunotherapy did not further improve survival in the induction CI group.
Conclusion
The addition of induction chemoimmunotherapy to CCRT was associated with improved survival in patients with locally advanced unresectable ESCC, particularly in responders to induction chemoimmunotherapy, with acceptable toxicity. These findings warrant confirmation in prospective randomized trials.
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