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This study aimed to evaluate the safety and efficacy of neoadjuvant tislelizumab combined with chemoradiotherapy in patients with resectable esophageal squamous cell cancer. It also investigates the changes in immune markers after treatment. This is an open-label, single-arm, single-institution phase 2 clinical trial. A total of 21 patients with newly diagnosed resectable esophageal cancer (cT1-2N+ / cT3-4aN0-3 M0) received 2 cycles of tislelizumab (200mg every 3 weeks for 2 cycles) concurrent with chemoradiotherapy. Radical esophagectomy was conducted within 4-6 weeks after neoadjuvant therapy. Baseline and pre-surgery PET/CT scans were performed to assess treatment response. Primary endpoints included pathological response rate (pCR) and major pathological response rate (MPR), the secondary endpoints were disease free survival and safety. Exploratory endpoints include molecular imaging research and immunological markers alterations in tumor microenvironment and circulating to further explore the factors affecting the efficacy of neoadjuvant therapy for esophageal cancer. A total of 21 patients were enrolled, and all received neoadjuvant tislelizumab combined with chemoradiotherapy, with 19 patients underwent radical esophagectomy. One patient underwent radical chemoradiotherapy due to lymph node metastases after neoadjuvant therapy. One patient died of pneumonia before surgery. Among 19 patients who underwent surgery, R0 was 100% (19/19),10 achieved pCR (52.6%), and 14 achieved MPR (73.7%). Most of treatment-related adverse event (TRAE) were grade 1-2. Grade ≥3 TRAEs included 1 anemia, 1 leukopenia, 1 neutropenia, 1 liver damage, 1 thrombocytopenia, and 1 elevated cardiac troponin T. A significant reduction in SUVmax of tumor was observed in both pCR and no-pCR patients after treatment. And SUVmax in no-pCR patients tended to be higher than pCR patients. Following neoadjuvant treatment, a significant increase of CD4+ T cells, CD8+ T cells, and memory T cells was observed within the TME. Patients with pCR had significant increase in the infiltration of CD4+ T cells, CD8+ T cells, and CD4+ Tm cells in tumor area. And significant increase in circulating CD4+ T cells, CD4+ effector memory T cells, and M1 macrophages was found after treatment. Moreover, a notably higher presence of CD4+ Tem cells and DC cells is observed in patients achieving pCR. Neoadjuvant tislelizumab combined with chemoradiotherapy for locally advanced ESCC has promising efficacy and good safety and enhances tumor immune infiltration and immunologic memory. [ABSTRACT FROM AUTHOR]

The objective of the study was to compare geometrical differences of target volumes based on four-dimensional computed tomography ( 4DCT) maximum intensity projection ( MIP) and 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/ CT) images of primary thoracic esophageal cancer for radiation treatment. Twenty-one patients with thoracic esophageal cancer sequentially underwent contrast-enhanced three-dimensional computed tomography ( 3DCT), 4DCT, and 18 F-FDG PET/CT thoracic simulation scans during normal free breathing. The internal gross target volume defined as IGTVMIP was obtained by contouring on MIP images. The gross target volumes based on PET/CT images ( GTVPET) were determined with nine different standardized uptake value ( SUV) thresholds and manual contouring: SUV ≥ 2.0, 2.5, 3.0, 3.5 ( SUV n); ≥20%, 25%, 30%, 35%, 40% of the maximum (percentages of SUVmax, SUV n%). The differences in volume ratio ( VR), conformity index ( CI), and degree of inclusion ( DI) between IGTVMIP and GTVPET were investigated. The mean centroid distance between GTVPET and IGTVMIP ranged from 4.98 mm to 6.53 mm. The VR ranged from 0.37 to 1.34, being significantly ( P < 0.05) closest to 1 at SUV2.5 (0.94), SUV20% (1.07), or manual contouring (1.10). The mean CI ranged from 0.34 to 0.58, being significantly closest to 1 ( P < 0.05) at SUV2.0 (0.55), SUV2.5 (0.56), SUV20% (0.56), SUV25% (0.53), or manual contouring (0.58). The mean DI of GTVPET in IGTVMIP ranged from 0.61 to 0.91, and the mean DI of IGTVMIP in GTVPET ranged from 0.34 to 0.86. The SUV threshold setting of SUV2.5, SUV20% or manual contouring yields the best tumor VR and CI with internal-gross target volume contoured on MIP of 4DCT dataset, but 3DPET/CT and 4DCT MIP could not replace each other for motion encompassing target volume delineation for radiation treatment. [ABSTRACT FROM AUTHOR]

The survival advantage of radiotherapy (RT) for patients with metastatic esophagus cancer has not been adequately evaluated. This study aims to find out the role of RT for metastatic esophagus cancer and to find the different effect for RT to esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC). This study included 5,970 metastatic esophagus cancer patients from the Surveillance, Epidemiology, and End Results (SEER) database, registered from January 2004 to December 2013. Propensity score (PS) analysis with 1:1 nearest neighbor matching method was used to ensure well-balanced characteristics of all comparison groups by histological types. The Kaplan-Meier and Cox proportional hazardous models were used to evaluate the overall survival (OS), cancer-specific survival (CSS), and corresponding 95% confidence interval (CI). Generally speaking, EAC did not get survival benefit from RT (median OS for RT group vs. no-RT group—8.0, 7.6–8.4 vs. 9.0, 8.5–9.5, P  = 0.073), whereas RT for metastatic ESCC did significantly improve OS (median OS for RT group vs. no-RT group—8.0, 7.4–8.6 vs. 7.0, 6.4–7.6, P  = 0.044). Therefore, compared with adenocarcinoma, ESCC could get more survival benefit from RT. [ABSTRACT FROM AUTHOR]