{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T20:28:08Z","timestamp":1758054488342,"version":"3.44.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T00:00:00Z","timestamp":1757894400000},"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. Oncol."],"abstract":"<jats:p>Patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC) typically have a poor prognosis, and concurrent chemoradiotherapy is the primary treatment modality. However, elderly patients often exhibit lower completion rates of concurrent chemoradiotherapy due to multiple comorbidities and reduced treatment tolerance, which directly affects their prognosis. Although apatinib combined with radiotherapy has demonstrated synergistic potential in treating certain solid tumors, its efficacy in elderly patients with LA-ESCC remains unclear. This case report involves an elderly patient with unresectable LA-ESCC who was treated with apatinib combined with intensity-modulated radiation therapy, The patient had comorbidities, including hypertension and diabetes, and declined chemotherapy. We implemented a treatment regimen consisting of intensity-modulated radiation therapy combined with low-dose apatinib. After nine sessions of radiotherapy, the patient\u2019s dysphagia significantly improved, and follow-up computed tomography revealed marked tumor shrinkage. As of July 2024, the patient has achieved a progression-free survival of 71 months without experiencing severe (Grade III\/IV) adverse reactions. Therefore, apatinib combined with radiotherapy suggests potential benefits as a concurrent treatment option for elderly patients with unresectable LA-ESCC.<\/jats:p>","DOI":"10.3389\/fonc.2025.1655976","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T04:13:09Z","timestamp":1757909589000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Apatinib combined with IMRT concurrent therapy achieves rapid response and significantly prolongs progression-free survival in elderly patients with inoperable locally advanced esophageal squamous cell carcinoma"],"prefix":"10.3389","volume":"15","author":[{"given":"Juan","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ning","family":"Zan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tingwu","family":"Yi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheng","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shi","family":"Liang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834","article-title":"Global Cancer Statistics 2022. GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph14030218","article-title":"Trends in esophageal cancer mortality in rural China from 1989 to 2013: An age-period-cohort analysis","volume":"14","author":"Gao","year":"2017","journal-title":"Int J Environ Res Public Health"},{"key":"B3","doi-asserted-by":"publisher","first-page":"83","DOI":"10.21037\/atm.2017.10.31","article-title":"Frontline esophageal cancer treatment: questions to be asked and answered","volume":"6","author":"Tu","year":"2018","journal-title":"Ann Transl Med"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(07)70172-9","article-title":"Therapeutic strategies for esophageal carcinoma: Role of surgery and other modalities","volume":"8","author":"Mariette","year":"2007","journal-title":"Lancet Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60643-6","article-title":"Oesophageal carcinoma","volume":"381","author":"Pennathur","year":"2013","journal-title":"Lancet"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2010.12.001","article-title":"Definitive chemoradiation for oesophageal cancer\u2013 A standard of care in patients with non-metastatic oesophageal cancer","volume":"23","author":"Gwynne","year":"2011","journal-title":"Clin Oncol (R Coll Radiol)"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2024.110517","article-title":"Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable esophageal squamous cell carcinoma: a pooled analysis of randomized clinical trials","volume":"200","author":"Yang","year":"2024","journal-title":"Radiother Oncol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1186\/s13014-018-1183-y","article-title":"Outcomes of concurrent chemoradiotherapy versus chemotherapy alone for stage IV esophageal squamous cell carcinoma: a retrospective controlled study","volume":"13","author":"Lyu","year":"2018","journal-title":"Radiat Oncol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1097\/COC.0b013e3180ca7c84","article-title":"A retrospective study of definitive chemoradiotherapy in elderly patients with esophageal cancer","volume":"30","author":"Takeuchi","year":"2007","journal-title":"Am J Clin Oncol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.34030","article-title":"Comparison of concurrent chemoradiotherapy with radiotherapy alone for locally advanced esophageal squamous cell cancer in elderly patients: A randomized multicenter phase II clinical trial","volume":"151","author":"Liu","year":"2022","journal-title":"Int J Cancer"},{"key":"B11","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1186\/s12957-023-03055-0","article-title":"Efficacy and safety of apatinib combined with radiotherapy in the treatment of advanced pancreatic cancer: a meta-analysis","volume":"21","author":"Ma","year":"2023","journal-title":"World J Surg Oncol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.addr.2017.01.004","article-title":"Radiotherapy for cancer: Present and future","volume":"109","author":"Allen","year":"2017","journal-title":"Adv Drug Delivery Rev"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.2147\/CMAR.S160909","article-title":"Dose-escalated radiotherapy improved the survival of patients with esophageal cancer with a complete clinical response after standard-dose radiotherapy with concurrent chemotherapy","volume":"10","author":"Zhang","year":"2018","journal-title":"Cancer Manag Res"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.3409","article-title":"Comparison between the effects of elective nodal irradiation and involved-field irradiation on long-term survival in thoracic esophageal squamous cell carcinoma patients: A prospective, multicenter, randomized, controlled study in China","volume":"9","author":"Lyu","year":"2020","journal-title":"Cancer Med"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199206113262403","article-title":"Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus","volume":"326","author":"Herskovic","year":"1992","journal-title":"N Engl J Med"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.12.7878","article-title":"Hypoxic radiosensitization: Adored and ignored","volume":"25","author":"Overgaard","year":"2007","journal-title":"J Clin Oncol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1111\/jcmm.17209","article-title":"Apatinib inhibits tumour progression and promotes antitumour efficacy of cytotoxic drugs in oesophageal squamous cell carcinoma","volume":"26","author":"Chi","year":"2022","journal-title":"J Cell Mol Med"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1038\/s41401-018-0058-y","article-title":"Apatinib, a selective VEGFR2 inhibitor, improves the delivery of chemotherapeutic agents to tumors by normalizing tumor vessels in LoVo colon cancer xenograft mice","volume":"40","author":"Zhou","year":"2019","journal-title":"Acta Pharmacol Sin"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.lfs.2019.117106","article-title":"Therapeutic potentials of Apatinib in cancer treatment: Possible mechanisms and clinical relevance","volume":"241","author":"Fathi Maroufi","year":"2020","journal-title":"Life Sci"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.4143\/crt.2019.296","article-title":"Apatinib combined with local irradiation leads to systemic tumor control via reversal of immunosuppressive tumor microenvironment in lung cancer","volume":"52","author":"Liang","year":"2020","journal-title":"Cancer Res Treat"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20220550","article-title":"Efficacy of apatinib+radiotherapy vs radiotherapy alone in patients with advanced multiline therapy failure for non small cell lung cancer with brain metastasis","volume":"96","author":"Pan","year":"2023","journal-title":"Br J Radiol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.22719","article-title":"Apatinib alone or combined with radiotherapy in metastatic prostate cancer: Results from a pilot, multicenter study","volume":"8","author":"Zhao","year":"2017","journal-title":"Oncotarget"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.1250","article-title":"Treatment utilization and outcomes in elderly patients with locally advanced esophageal carcinoma: A review of the National Cancer Database","volume":"6","author":"Vlacich","year":"2017","journal-title":"Cancer Med"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6604749","article-title":"Safety and outcome of definitive chemoradiotherapy in elderly patients with oesophageal cancer","volume":"99","author":"Tougeron","year":"2008","journal-title":"Br J Cancer"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.21873\/anticanres.13592","article-title":"Is concurrent chemotherapy with radiotherapy for esophageal cancer beneficial in patients aged 80 years or older","volume":"39","author":"Jingu","year":"2019","journal-title":"Anticancer Res"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2020-0310","article-title":"Safety and efficacy of apatinib monotherapy for unresectable, metastatic esophageal cancer: A single-arm, open-label, Phase II study","volume":"25","author":"Yanwei","year":"2020","journal-title":"Oncologist"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.927221","article-title":"The safety and efficacy of apatinib treatment in addition to concurrent chemoradiotherapy in patients with nonoperative locally advanced esophageal squamous cell carcinoma","volume":"26","author":"Hu","year":"2020","journal-title":"Med Sci Monit"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/86.17.1303","article-title":"Altered angiogenesis underlying age-dependent changes in tumor growth","volume":"86","author":"Pili","year":"1994","journal-title":"J Natl Cancer Inst"},{"key":"B29","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). Radiation Therapy Oncology Group","volume":"281","author":"Cooper","year":"1999","journal-title":"JAMA"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2008.06.025","article-title":"Esophagorespiratory fistulas of tumorous origin. Non-operative management of 264 cases in a 20-year period","volume":"34","author":"Balazs","year":"2008","journal-title":"Eur J Cardiothorac Surg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e0251811","DOI":"10.1371\/journal.pone.0251811","article-title":"Esophageal fistula after definitive concurrent chemotherapy and intensity modulated radiotherapy for esophageal squamous cell carcinoma","volume":"16","author":"Pao","year":"2021","journal-title":"PloS One"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0b013e3181858eba","article-title":"Tracheo-esophageal fistula with bevacizumab after mediastinal radiation","volume":"3","author":"Goodgame","year":"2008","journal-title":"J Thorac Oncol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0b013e3181c06a6f","article-title":"Tracheoesophageal fistula associated with bevacizumab 21 months after completion of radiation therapy","volume":"4","author":"Gore","year":"2009","journal-title":"J Thorac Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1655976\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T04:13:16Z","timestamp":1757909596000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1655976\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,15]]},"references-count":33,"alternative-id":["10.3389\/fonc.2025.1655976"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2025.1655976","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,15]]},"article-number":"1655976"}}