The purpose of this study is to compare the efficacy and safety of concurrent chemoradiotherapy (CCRT) versus chemotherapy alone for patients with stage IV esophageal squamous cell carcinoma (ESCC). Eligible patients were retrospectively enrolled at the authors’s institution from January 2010 to October 2015. Of the 141 patients enrolled, 55 (39.0%) received CCRT and 86 (61.0%) received chemotherapy alone. The outcomes and adverse events (AEs) were compared between the two groups. The baseline clinical characteristics of the two groups were similar. However, the CCRT group showed a significantly better primary tumor objective response rate (ORR) than that of the chemotherapy group (74.5% versus 45.3%, p = 0.001). The 1-year, 2-year, 3-year overall survival (OS) rates and median OS were 58.0% versus 43.0%, 25.5% versus 14.0%, 10.7% versus 4.7%, and 14 months versus 11 months for patients treated with CCRT or chemotherapy, respectively (p = 0.007). The 1-year and median progression-free survival (PFS) were 29.8% versus 14.9% and 8 months versus 6 months (p = 0.005). Multivariate analysis identified CCRT (p = 0.013) and solitary metastasis (p = 0.037) as independent factors for greater OS. The frequency of leucocytopenia (grade 3 or higher) was significantly higher in the CCRT group than in the chemotherapy-alone group (p = 0.040), whereas the rates of other AEs did not differ. In this study, it is suggested that CCRT is more effective than chemotherapy alone for stage IV ESCC, yielding better primary responses and survival outcomes with tolerable side effects.

Esophageal cancer (EC) patients receiving radiotherapy are at a high risk of malnutrition, which can increase the side effects of radiotherapy, reduce the accuracy and sensitivity of radiotherapy and decrease treatment effect. Therefore, timely and correct nutritional treatment is crucial. To date, however, neither consensus nor guidelines on enteral nutrition (EN) specifically for EC patients receiving radiotherapy exist. Accordingly, an expert consensus conference was held to establish consensus on the use of EN in EC patients receiving radiotherapy. It reflected the opinions of a multidisciplinary group of experts and a review of the current literature, and established common guidelines for nutritional screening and assessment, nutrition counseling, indication for EN, access and formulas of EN, effect evaluation, nutrition plan adjustment, and home enteral nutrition. Graphical abstract

Background and purpose: Sarcopenia has been demonstrated to be adversely correlated with the prognosis of various cancers. Our study aimed to estimate the prognostic value of sarcopenia in conjunction with inflammatory indices [neutrophil-to-lymphocyte ratio (NLR)] for evaluating the prognosis of patients with esophageal squamous cell carcinoma (ESCC) undergoing chemoradiotherapy. Materials and methods: This study retrospectively analyzed 255 patients with ESCC who received chemoradiotherapy from January 2012 to December 2018. Multivariate Cox regression analysis was employed to identify prognostic values of assessed factors following a novel prognostic scoring system (SMI-NLR), covering sarcopenia and NLR during different treatment courses. Results: Kaplan–Meier analysis revealed significantly greater overall survival (OS) rates in the nonsarcopenia group than in the sarcopenia group (P = 0.011). The low NLR group (< 4.84) demonstrated significantly higher OS rates than the high NLR group (≥ 4.84) (P < 0.001). The SMI-NLR prognostic model was established through multivariate analysis, revealing that Karnofsky performance status [hazard ratio (HR) = 0.285; 95% confidence interval (CI) = 0.117–0.699; P = 0.006], clinical staging (HR = 5.223; 95% CI = 1.879–14.514; P = 0.002), and preSMI-NLR (HR = 0.544; 95% CI = 0.330–0.898; P = 0.017) were independent factors affecting the prognosis of patients with ESCC. Nomograms were constructed based on these data providing more accurate 1-, 3-, and 5-year survival rates for patients with ESCC. Conclusion: Our study indicates the effectiveness of the combined sarcopenia and NLR prognostic model for the prognostic evaluation of patients with ESCC having undergone chemoradiotherapy.

Malignant tumors continue to pose a significant threat to global health. Emerging evidence suggests that abnormal blood lipid levels may influence tumor incidence, and cancer patients frequently exhibit dysregulated lipid profiles. Radiotherapy, a cornerstone in cancer treatment, has been demonstrated to modulate blood lipid levels in patients. Conversely, blood lipid concentrations can significantly impact the efficacy of radiotherapy and the incidence of associated complications. This comprehensive review delves into cutting-edge research illuminating the intricate bidirectional interplay between blood lipid profiles and radiotherapy efficacy in malignant tumor patients. At the same time, it investigates the promising potential of tailored dietary modulation strategies and novel lipid-lowering therapeutics to enhance treatment efficacy and patient prognosis.

BACKGROUND Patients with esophageal cancer exhibit marked variability in prognosis, highlighting the need for metabolism-related biomarkers. Although metabolic reprogramming is considered to be correlated with the prognosis of patients with esophageal squamous cell carcinoma (ESCC), its specific association mechanisms remain unclear. AIM To explore the triglyceride-glucose (TyG) index and its derivatives - indicators for insulin resistance, a core feature of metabolic syndrome. Given their controversial associations with cancer and limited research on their dynamic changes in ESCC patients post-treatment, this study aims to analyze these dynamic changes. METHODS The present retrospective study analyzed 360 East Asian patients with ESCC who received definitive chemoradiotherapy to explore the associations of TyG, TyG-body weight, and TyG-body mass index (both pre- and post-treatment) with overall survival. RESULTS Elevated levels of post-treatment TyG and its derivatives (postTyG, postTyG-body weight, postTyG-body mass index) were significantly associated with a reduced risk of death, showing a superior prognostic value compared to the baseline levels (preTyG). Restricted cubic spline analysis confirmed the presence of non-linear or monotonic associations, with more pronounced correlations observed in male patients. CONCLUSION Post-treatment TyG and its derivatives may serve as independent prognostic indicators for East Asian patients with ESCC, providing a basis for personalized diagnosis and treatment.

The relationship between CT-based body composition parameters and chemoradiotherapy outcomes in patients with esophageal squamous cell carcinoma (ESCC) is unclear. This study aimed to clarify the predictive value of myosteatosis and subcutaneous adipose tissue area (SATA) in ESCC patients undergoing chemoradiotherapy. The study cohort consisted of 255 ESCC patients undergoing chemoradiotherapy between January 2012 and December 2018. Body composition parameters, such as mean muscle density in Hounsfield units (HU) and adipose tissue area at the third lumbar vertebra (L3) level, were quantified on CT scans. Hazard ratios were estimated to establish the relationship between pretreatment skeletal muscle density (preSMD) and adipose tissue area with the overall survival (OS) rate. Optimal stratification was utilized to set threshold values. Kaplan–Meier plots and Cox proportional hazards models were developed to analyze survival distributions. Among 255 ESCC patients who received chemoradiotherapy, the median survival time was 24.3 months (95% CI 20.33–33.8). Multivariate analysis revealed that tumor length (HR = 1.547; 95% CI 1.115–2.145; P = 0.009), clinical stage (HR = 5.696; 95% CI 2.053–15.798; P < 0.001), and preSMD (HR = 1.528; 95% CI 1.079–2.169; P = 0.017) were independent indicators for OS. Additionally, SATA emerged as an independent predictor of preSMD (HR = 0.991; 95% CI 0.986–0.996; P = 0.038). A nomogram integrating preSMD, pretreatment subcutaneous adipose tissue area (preSATA), and independent prognostic factors effectively predicts the prognosis of ESCC patients, supplementing the TNM staging system. The study suggests that a prognostic model combining preSMD and preSATA effectively predicts the prognosis of ESCC patients undergoing chemoradiotherapy.