Background: The efficacy of immunochemotherapy (ICT) remains poor in patients with polymetastases from esophageal squamous cell carcinoma (ESCC). While radiation therapy (RT) has shown promise in oligometastatic settings, its role when combined with ICT for polymetastatic ESCC (with >5 metastatic lesions) remains unclear. Objective: This study evaluated the efficacy and value of RT in patients with polymetastatic ESCC who received ICT as first-line treatment. Design: This multi-center cohort study was conducted at 20 hospitals in China. Methods: In total, 331 patients who received at least one cycle of first-line ICT between January 2019 and December 2021 were enrolled. Among them, 88 received ICT plus RT (RT group), and 243 received ICT alone (non-RT group). Propensity score matching (PSM) was performed to control for potential confounders (75 patients/group). Outcomes included overall survival (OS), progression-free survival, objective response rate (ORR), symptom control, and safety. This study was registered at the Clinicaltrials.gov registry (identification number NCT 05142709). Results: Both before and after PSM, no significant OS benefit was observed with RT group (median OS: 15.2 vs 12.2 months, hazard ratio (HR) 0.80 (0.60–1.07), p = 0.14; 15.0 vs 11.0 months, HR 0.80 (0.55–1.15), p = 0.23, respectively), though pre-PSM ORR favored RT (59.1% vs 40.3%, p = 0.003). RT demonstrated superior symptom control, with significantly higher rates of dysphagia improvement (63.3% vs 36.4%, p = 0.0006) and meaningful pain reduction (59.4% vs 40.0%, p = 0.007). Grade ⩾3 treatment-related adverse events were comparable between groups (38 vs 40 cases post-PSM, p = 0.74), with equivalent grade 5 toxicities (1.3% each). Conclusion: For polymetastatic ESCC, RT combined with ICT enhanced symptom control without severe toxicity, though it did not improve survival. This supports its personalized use for quality of life in symptomatic patients.
Liu et al. (Sun,) studied this question.