DISCUSSION
esophageal cancer, pneumonitis, dysphagia, toxicities, toxic, ESCC, perforation, esophagitis
DYSPHAGIA, PNEUMONITIS, RADIATION ESOPHAGITIS, OESOPHAGEAL CANCER, MALNUTRITION, NFT, ESOPHAGITIS, MASSIVE BLEEDING, COMPLICATIONS
Pretreatment PEG‐based CCRT showed promising treatment response and tolerable CCRT‐induced toxicities in unresectable locally advanced ESCC patients. The loco‐regional ORR and 1‐year LRFS were 98.4% and 88.3%. The incidence of grade ≥3 esophagitis was 14.3% (9/63) and no patient experienced grade ≥3 pneumonitis. In the current study, we also compared the efficacies, toxicities, nutrition status, and costs of three different enteral support groups. PEG group showed higher loco‐regional ORR (PEG group: 98.4% vs. NTF group: 90.4% vs. ONS group: 90.5%, Our previous results found that the incidence of grade ≥3 radiation esophagitis including massive bleeding and perforation was significantly lower in ESCC patients with PEG (Malnutrition predicts poor prognosis for esophageal cancer patients treated with chemotherapy or/and radiotherapy.Six patients in the PEG group developed complications (We also found that the total costs of the PEG group from diagnosis till 6 months after CCRT were slightly lower among 3 groups (PEG group: $16,918.55 vs. NTF group: $19,123.92 vs. ONS group: $18,399.01, To identify which treatment approaches are of the best value, we retrieved results from three prospective studies to compare the cost‐effectiveness of PEGs, NTFs, and ONS. We found that PEG is cost‐effective compared with NTF and ONS groups. Although ONS is more affordable, equally effective, and probably less toxic than NTF, we included NTF as a comparator because most patients with dysphagia are still undergoing NTF in China. Probabilistic sensitivity analysis showed that ONS is by no means to be a cost‐effective treatment unless the threshold of cost‐effectiveness analysis sharply fell to $5000 per QALY (Figure Our study has several potential limitations. First, our model‐derived short‐term costs related to the CCRT should not be extrapolated and was based on data from the observation period. However, it is inadequate for short‐term costs to represent the long‐term healthcare costs associated with living status. Second, the results of economic evaluations estimated for one country might not apply elsewhere. Further clinical trial compared these enteral nutrition supports was needed. Third, the concurrent chemotherapy regimen differs in three groups, with S1 in the PEG group and platinum‐based doublet regimen in NFT and ONS groups. Although previous trials using S‐1 as concurrent chemotherapy reported a comparable ORR rate and survival to those with DP‐ or PF‐based CCRT,