Long-term outcomes and exploratory analysis from a randomized phase 3 trial of radiation dose escalation in definitive chemoradiotherapy for locally advanced esophageal squamous cell carcinoma.
Drug Resist UpdatJul 9, 2026 (epub)
Qi Cheng, Baiqiang Dong, Weiguo Zhu et al.
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In 30 seconds
This randomized phase 3 trial evaluated the long-term outcomes of radiation dose escalation (60 Gy vs 50 Gy) in 324 patients with locally advanced esophageal squamous cell carcinoma (ESCC). After a median follow-up of 99.5 months, no significant differences were found in locoregional progression-free survival, with 5-year rates of 41.8% for 60 Gy and 43.3% for 50 Gy (HR 1.06, p = 0.70).
Key findings
- 5-year locoregional progression-free survival rates were 41.8% for 60 Gy and 43.3% for 50 Gy.
- No significant differences in overall survival or progression-free survival between the two radiation doses.
- Long survivors exhibited an immune-activated tumor profile, while early progressors showed an immunosuppressive profile.
- Spatial multi-omics analyses revealed distinct tumor microenvironment states linked to treatment outcomes.
Why it matters
The study reinforces the use of 50 Gy as the standard radiation dose for patients with locally advanced ESCC undergoing definitive chemoradiotherapy, highlighting the lack of benefit from dose escalation.