{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T06:00:21Z","timestamp":1785218421460,"version":"3.55.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>For patients with locally advanced esophageal squamous cell carcinoma (ESCC) ineligible for surgery, definitive radiotherapy (RT) is the primary curative-intent treatment, yet outcomes remain suboptimal. The benefit of adding induction immunotherapy combined with chemotherapy prior to RT in this setting is unclear. This real-world study compared survival and safety between induction chemoimmunotherapy followed by RT and RT alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center, retrospective cohort study enrolled 159 patients with inoperable locally advanced ESCC treated between May 2021 and December 2025. Patients were categorized into an induction treatment group (n=48) receiving PD-1 inhibitor-based chemoimmunotherapy before RT, and a no-induction (control) group (n=111) receiving RT alone. Details regarding unsystematically administered concurrent chemotherapy were not captured. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Toxicity was assessed per CTCAE v5.0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Baseline characteristics were balanced. The induction group most commonly received camrelizumab (29.2%) with a taxane-based backbone. With a median follow-up, no significant survival difference was observed. Median PFS was 16.2 months (95% CI: 6.03-26.37) vs. 16.5 months (9.91-23.09) in the induction vs. control groups, respectively (P\u00a0=\u00a00.734). Median OS was 25.8 months (7.13-44.47) vs. 24.1 months (15.18-33.02), respectively (P\u00a0=\u00a00.659). Subgroup analyses showed no statistically significant treatment\u2013subgroup interactions. Univariable analyses identified better nutritional status (NRS2002&amp;lt;3) as a favorable prognostic factor for both PFS and OS, and better performance status (ECOG PS 0-1) for OS. The induction group had significantly higher rates of Grade 3\u20134 adverse events, including neutropenia (60.4% vs. 7.2%), anemia (47.9% vs. 9.9%), thrombocytopenia (27.1% vs. 1.8%), and nausea (83.3% vs. 6.3%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this real-world cohort of inoperable locally advanced ESCC patients, adding induction chemoimmunotherapy before definitive radiotherapy was not associated with improved PFS or OS but led to a significantly increased burden of severe toxicities compared to RT alone. These findings do not support the routine use of this intensive sequential strategy in an unselected, often frail, inoperable population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1831726","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T05:37:35Z","timestamp":1785217055000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Induction chemoimmunotherapy versus radiotherapy alone for inoperable esophageal squamous cell carcinoma: a real-world study"],"prefix":"10.3389","volume":"17","author":[{"given":"Junhui","family":"Wang","sequence":"first","affiliation":[{"name":"Department of International Ward, Quzhou People\u2032s Hospital, The Quzhou Affiliated Hospital, Wenzhou Medical University","place":["Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianxin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of International Ward, Quzhou People\u2032s Hospital, The Quzhou Affiliated Hospital, Wenzhou Medical University","place":["Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa2409408","article-title":"Perioperative chemotherapy or preoperative chemoradiotherapy in esophageal cancer","volume":"392","author":"Hoeppner","year":"2025","journal-title":"N Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2021.2373","article-title":"Long-term efficacy of neoadjuvant chemoradiotherapy plus surgery for the treatment of locally advanced esophageal squamous cell carcinoma: The NEOCRTEC5010 randomized clinical trial","volume":"156","author":"Yang","year":"2021","journal-title":"JAMA Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.ejca.2015.11.024","article-title":"Role of neoadjuvant treatment in clinical T2N0M0 oesophageal cancer: results from a retrospective multi-center European study","volume":"56","author":"Markar","year":"2016","journal-title":"Eur J Cancer"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.281.17.1623","article-title":"Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). 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