Discussion
ESCC, alBased
SENSITIVITY
This phase III randomized clinical trial assessed the effectiveness of SIB-RT with concurrent and consolidated chemotherapy in patients aged 70 years and older with ESCC. The findings suggest that patients treated with SIB-RT combined with oral S-1 chemotherapy experienced significant improvement in OS and PFS compared with SIB-RT alone and acceptable treatment-related toxic effects, indicating that SIB-RT with oral S-1 chemotherapy could be an appropriate treatment approach for patients aged 70 years and older.Patients tend to tolerate intravenous chemotherapy less well with age, and patients aged 70 years and older are at increased risk of treatment-related toxic effects. A 2011 multicenter study found that when treated with intravenous chemotherapy, more than 50% of patients older than 65 years encountered at least 1 grade 3 to 5 toxic effect and 2% died as result of treatment-related toxic effects.In this study, we observed an improvement of OS in the CRTCT group through ITT analysis. Sensitivity analyses also showed significant survival benefit in the CRTCT group. In addition, the incidence of severe toxic effects in the CRTCT group was not significantly increased compared with that in the RT group. Analogously, a 2021 phase III randomized clinical trial conducted by Ji et alBased on our previous prospective phase I/II dose escalation study of SIB-RT concurrent with weekly chemotherapy of paclitaxel and nedaplatin as chemoradiotherapy for patients younger than 70 years with locally advanced ESCC, we recommended boosting the dose to the PGTV to 59.92 Gy (EQD2, 60.62 Gy), with a standard dose of 50.4 Gy to the PTV.