SIB-RT plus S-1 improves survival in elderly inoperable esophageal cancerCombination therapy improves survival in older esophageal cancer patients

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology Published May 1, 2026 Study authors: Chen Junqiang, Chang Xiao, Liu Wenyang, Wang Xiaomin, Ge Xiaolin, Liu Ke, Deng Lei, Hu Miaomiao, Lu … PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider CRTCT (SIB-RT plus S-1) as a potential standard for elderly inoperable ESCC, but note unreported safety data.

This phase III multicenter randomized controlled trial evaluated the efficacy of simultaneous integrated boost radiotherapy (SIB-RT) combined with oral S-1 chemotherapy (CRTCT) versus radiotherapy alone in patients aged ≥70 years with inoperable esophageal squamous cell carcinoma. The sample size was not reported. Median follow-up was 75 months.

The primary outcome was overall survival (OS). The CRTCT group showed significantly longer OS compared to radiotherapy alone (hazard ratio [HR] 0.74; 95% CI 0.57-0.95; P=0.02). Five-year OS rates were 34.1% in the CRTCT group versus 23.6% in the control group. Progression-free survival was also improved (31.1% vs. 20.9%; P=0.02), as was restricted mean survival time (33.0 vs. 27.0 months; P=0.02). Locoregional failure was reduced in the CRTCT group (HR 0.64; 95% CI 0.45-0.92; P=0.02).

Safety data, including adverse events, serious adverse events, and discontinuations, were not reported. Limitations were not specified in the available data. Funding and conflicts of interest were not reported.

For clinical practice, this regimen might be considered a standard of care for elderly patients with inoperable esophageal squamous cell carcinoma, though the absence of safety information warrants caution. The results are based on a single trial with unreported sample size and limitations.

A new clinical trial shows that combining a chemotherapy drug called S-1 with a precise form of radiation therapy helps older patients with inoperable esophageal cancer live longer. The study included patients aged 70 and older who could not have surgery. They were given either radiation alone or radiation plus S-1 chemotherapy.

After a median follow-up of 75 months, the group receiving both treatments had better overall survival. At five years, 34.1% of patients in the combination group were alive, compared with 23.6% in the radiation-only group. The combination also improved progression-free survival and reduced the chance of the cancer returning in the same area.

The study did not report on side effects or how well patients tolerated the treatment. This information is important for understanding the full picture. The results are promising, but more details on safety are needed before this becomes a standard approach.

For now, this treatment option may be considered for older patients with inoperable esophageal cancer. Anyone considering this therapy should discuss the potential benefits and risks with their doctor.

What this means for you:

Adding S-1 chemo to radiation may improve survival in older patients with inoperable esophageal cancer.

Study Details

Study typeRct

EvidenceLevel 2

Follow-up60.0 mo

PublishedMay 2026

PMID41412437

View Original Abstract ↓

PURPOSE: This study reports the long-term outcomes of simultaneous integrated boost radiotherapy (SIB-RT) combined with oral S-1 chemotherapy (CRTCT) in inoperable patients aged ≥ 70 years with inoperable esophageal squamous cell carcinoma (ESCC). METHODS: In this multicenter, phase III randomized trial, patients with inoperable, locally advanced stage II-IV ESCC were randomized to receive either CRTCT or RT alone. The primary endpoint was overall survival (OS); secondary endpoints included progression-free survival (PFS), restricted mean survival time (RMST), and patterns of failure. RESULTS: After a median follow-up of 75 months, patients in the CRTCT group had longer OS than those in the RT group (hazard ratio (HR), 0.74; 95 % confidence interval (CI), 0.57-0.95; P = 0.02), with better 5-year OS rates (34.1 % vs. 23.6 %,P = 0.02), PFS (31.1 % vs. 20.9 %,P = 0.02), and RMST (33.0 vs. 27.0 months,P = 0.02). CRTCT's effect on OS stabilized over 5 years. Locoregional failure was lower in the CRTCT group (HR, 0.64; 95 % CI, 0.45-0.92; P = 0.02), with similar distant and mixed failure risks. CONCLUSIONS: SIB-RT combined with oral S-1 chemotherapy significantly improved long-term survival and therefore might be considered a standard of care for elderly patients with inoperable ESCC. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT0297969.

SIB-RT plus S-1 improves survival in elderly inoperable esophageal cancerCombination therapy improves survival in older esophageal cancer patients

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