Efficacy analysis of first-line chemoimmunotherapy with or without radiotherapy in stage IVB esophageal squamous cell carcinoma: a real-world study

BACKGROUND: This study assessed whether adding radiotherapy (RT) to first-line chemoimmunotherapy (ICT) improves outcomes in stage IVB esophageal squamous cell carcinoma (ESCC), given the limited benefit of ICT alone. METHODS: After 1:1 propensity score matching, 280 patients with stage IVB ESCC were included, with 140 receiving ICT plus RT (ICRT) and 140 receiving ICT alone. RESULTS: = 0.012) compared with ICT alone. Concurrent and sequential RT showed no significant survival difference in this post hoc analysis. Patients with non-regional lymph node metastases and those receiving RT doses ≥60 Gy showed greater PFS benefit. However, severe hematologic toxicity, particularly lymphopenia (30.71% vs. 3.57%), was more common with ICRT. CONCLUSION: Adding RT to ICT improved survival in stage IVB ESCC. Despite increased toxicity, overall safety was manageable.