Author(s)

Pengyu Bao

Corresponding Author

Pengyu Bao

Abstract

Esophageal cancer is a highly prevalent malignant tumor of the digestive system, with cases in China accounting for more than half of the global total. Chemotherapy and chemoradiotherapy are important treatment modalities for this disease. This study compared the efficacy, safety, and clinical controversies of the two approaches. In terms of efficacy, chemoradiotherapy showed significantly better performance than chemotherapy alone in local control rate (2-year rate: 70% vs. 40% for chemotherapy alone), distant metastasis rate (3-year rate: 35% vs. 50% for chemotherapy alone), and survival rate (5-year rate: 30% vs. 15% for chemotherapy alone), which is attributed to the synergistic effect of radiotherapy and chemotherapy. Regarding safety, both treatments are associated with adverse reactions, but chemoradiotherapy, due to the superimposition of adverse effects from radiotherapy and chemotherapy, not only causes common chemotherapy-related adverse reactions such as myelosuppression (leukopenia rate: 50%-70%) and gastrointestinal reactions (nausea and vomiting rate: 70%-80%) but also leads to radiotherapy-specific adverse reactions like radiation esophagitis (incidence rate: 60%-80%), resulting in a more severe impact on patients' quality of life. Clinical controversies mainly focus on the selection of treatment regimens (which needs to consider patients' physical status, tumor stage, and pathological type), the optimal timing and sequence of chemoradiotherapy (concurrent chemoradiotherapy has better efficacy but greater adverse reactions, while sequential chemoradiotherapy shows the opposite characteristics), the management and risk assessment of treatment-related complications (e.g., the incidence rate of esophageal fistula is 5.3%, and preoperative assessment of patients' nutritional status and cardiopulmonary function is required), and the follow-up and quality of life improvement for long-term survivors. In clinical practice, the pros and cons of chemotherapy and chemoradiotherapy should be balanced, and personalized treatment plans should be formulated based on patients' specific conditions to improve prognosis.

Keywords

Esophageal cancer; Chemotherapy; Chemoradiotherapy; Efficacy; Safety; Clinical controversies