Journal
JOURNAL OF CANCER RESEARCH AND CLINICAL ONCOLOGY
Volume -, Issue -, Pages -Publisher
SPRINGER
DOI: 10.1007/s00432-023-05499-z
Keywords
Immunotherapy; Radiotherapy; Radiotherapy combined with immunotherapy; Esophageal cancer; Immune checkpoint inhibitors; Low-dose radiotherapy
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The combination of radiotherapy and immunotherapy shows promise in the treatment of esophageal cancer and can trigger a systemic anti-tumor immune response.
BackgroundImmunotherapy has shown promise in the treatment of esophageal cancer, but using it alone only benefits a small number of patients. Most patients either do not have a significant response or develop secondary drug resistance. The combination of radiotherapy and immunotherapy appears to be a promising approach to treating esophageal cancer.PurposeWe reviewed milestone clinical trials of radiotherapy combined with immunotherapy for esophageal cancer. We then discussed potential biomarkers for radiotherapy combined with immunotherapy, including programmed cell death-ligand 1 (PD-L1) status, tumor mutation burden (TMB), tumor-infiltrating lymphocytes, ct-DNA, imaging biomarkers, and clinical factors. Furthermore, we emphasize the key mechanisms of radiation therapy-induced immune stimulation and immune suppression in order to propose strategies for overcoming immune resistance in radiation therapy (RT). Lastly, we discussed the emerging role of low-dose radiotherapy (LDRT) , which has become a promising approach to overcome the limitations of high-dose radiotherapy.ConclusionRadiotherapy can be considered a triggering factor for systemic anti-tumor immune response and, with the assistance of immunotherapy, can serve as a systemic treatment option and potentially become the standard treatment for cancer patients.
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