Objective This real-world study explores the efficacy and safety of radiotherapy combined with immunotherapy-based regimens in elderly patients (≥70 years) with esophageal squamous cell carcinoma (ESCC), stratified by the Cumulative Illness Rating Scale--Geriatric (CIRS-G). Given the exploratory nature and modest sample size, findings should be interpreted as hypothesis-generating. Methods We conducted a single-center retrospective analysis of 87 elderly ESCC patients receiving intensity-modulated radiotherapy, categorized into three groups: radiotherapy alone (RT, n=49), concurrent chemoradiotherapy (CRT, n=18), and radiotherapy combined with immunotherapy ± chemotherapy (RIT ± CT, n=20). The primary endpoint was overall survival (OS). Propensity score matching (PSM) and multivariable Cox regression were performed. Results With a median follow-up of 37 months, multivariable Cox regression analysis suggested that the RIT ± CT regimen was associated with a reduced mortality risk versus RT (HR = 0.341, 95% CI: 0.130–0.896, P = 0.029). PSM confirmed this survival advantage (OS: HR = 0.42, P = 0.028). Patients with a medium CIRS-G burden (scores 4–6) demonstrated the most significant OS benefit from this multimodal strategy. Grade ≥3 TRAEs were highest in the RIT ± CT group (55.0%), with no treatment-related deaths. Conclusion The integration of immunotherapy-based regimens into radiotherapy shows an association with improved survival in elderly ESCC patients with a manageable safety profile. The CIRS-G score may help identify optimal candidates. These exploratory findings require validation in larger, prospective multicenter studies. The independent contribution of immunotherapy alone cannot be determined from this study.
Ren et al. (2026) studied this question.