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esophageal cancer is a common malignant tumor of the digestive tract in my country. many patients are already in the locally advanced stage at the time of initial diagnosis. for patients with locally advanced disease who cannot undergo surgery or are not suitable for surgery, synchronous chemoradiotherapy is an important treatment method. in clinical practice, radiotherapy sensitizers are sometimes used to achieve better radiotherapy effects. in clinical practice, some patients with advanced esophageal cancer stop chemotherapy because they cannot tolerate synchronous chemoradiotherapy. under the radiosensitization of the radiotherapy sensitizer sodium glycidazole, radiotherapy is used to control tumor progression. professor deng lei of the cancer hospital of the chinese academy of medical sciences commented on such medical records.

radiotherapy plays an important role in the treatment of esophageal cancer

professor deng lei: radiotherapy, as one of the three classic tumor treatment methods, has important clinical application value in locally advanced esophageal cancer. in recent years, with the development of radiotherapy technology, new technologies such as three-dimensional conformal radiotherapy, intensity-modulated radiotherapy and image-guided technology have gradually been widely used in the treatment of esophageal cancer.

as a more complex stage, locally advanced esophageal cancer requires multidisciplinary treatment including radiotherapy. among them, for resectable locally advanced esophageal cancer, neoadjuvant synchronous chemoradiotherapy followed by surgery is the current standard treatment option. some patients also need adjuvant radiotherapy after surgery to achieve better local control rate and survival rate.

for unresectable locally advanced esophageal cancer, radical synchronous chemoradiotherapy is the primary treatment option recommended by authoritative guidelines at home and abroad. some patients may even have the opportunity for conversion surgery because of synchronous chemoradiotherapy, thereby receiving radical treatment and obtaining a better prognosis.

in recent years, some studies have explored the application of chemoradiotherapy combined with immunotherapy in unresectable locally advanced esophageal cancer, and have also obtained positive results. currently, some highly anticipated phase iii clinical studies are underway, and the results of the studies are expected to further enhance the clinical status of radiotherapy in unresectable locally advanced esophageal cancer.

the intensity of treatment should be adjusted according to the patient's tolerance. glycididazole sodium can safely enhance the sensitivity of radiotherapy.

professor deng lei: the treatment of unresectable locally advanced esophageal cancer emphasizes individualized treatment based on multidisciplinary disciplines, and the treatment plan should be adjusted for different patients based on their individual conditions. commonly used chemotherapy drugs in synchronous chemoradiotherapy for locally advanced esophageal cancer include platinum, fluorouracil, and paclitaxel. some patients may not be able to tolerate the adverse reactions of chemotherapy drugs due to poor tolerance, and may consider switching to safer chemotherapy drugs, such as s-1, raltitrexed, or capecitabine, or consider stopping chemotherapy. after chemotherapy is stopped, in order to ensure the therapeutic effect of radiotherapy, radiosensitizers may need to be used in combination. among solid tumors, including esophageal cancer, there may be hypoxic cells that are resistant to radiotherapy, and conventional radiotherapy is difficult to kill these tumor cells, leading to future recurrence and metastasis. targeted inhibition of such hypoxic cells is expected to improve the efficacy of radiotherapy and achieve better prognosis for patients who cannot tolerate synchronous chemoradiotherapy.

sodium glycidazole is the only radiosensitizer approved in china. it can easily diffuse and penetrate into tumor tissues and accumulate in tumor cells, selectively enhancing the effect of radiation on double-stranded dna damage in tumor cells (especially hypoxic cells) at the cellular molecular level, thereby enhancing radiosensitivity. in addition, sodium glycidazole has an inhibitory effect on dna repair enzymes, especially polymerase β, thereby inhibiting the repair of damaged dna molecules in tumor cells (especially hypoxic cells), further enhancing radiosensitivity. previously, in many clinical studies, the combined use of sodium glycidazole and radiotherapy has shown good sensitization effects without increasing toxic and side effects, and has very good safety.

radiotherapy combined with sensitizers is a clinically mature approach, but other combined approaches still have many problems to be solved.

professor deng lei: the combined "partners" of radiotherapy include radiosensitizers, chemotherapy, immunotherapy, etc. the combined use of radiotherapy and radiosensitizers is relatively mature and well tolerated by patients, and can be more widely used in current clinical practice. the combination of radiotherapy and immunotherapy is currently a popular direction of exploration, but there are still many problems to be solved in the application of combined solutions, such as safety management issues.

radiotherapy may lead to the production of systemic immune responses, which may overlap with the adverse reactions induced by immunotherapy and may lead to the risk of enhanced adverse reactions. therefore, patients who are suitable for radiotherapy combined with immunotherapy need to be carefully evaluated, including patients with poor physical condition, cachexia, poor cardiopulmonary function, and serious diseases of important organs. in the event of massive esophageal bleeding or esophageal fistula complicated by severe infection or esophageal fistula with obvious signs of perforation, the combined use of radiotherapy and immunotherapy should be avoided as much as possible.

the delineation of the radiotherapy target area also needs to be more precise, and a balance between efficacy and safety needs to be struck. especially in the application of combined regimens, more attention should be paid to avoid reducing the number of peripheral blood lymphocytes due to a large target area, which would have a negative impact on the patient's survival outcome. in addition, there is still no unified normative answer to the radiotherapy dose, fractionation method, timing of immunotherapy intervention, and the population that benefits from treatment, which need further exploration.

in short, the application of combined radiotherapy should pursue high efficiency and low toxicity. how to ensure the patient's treatment benefits while balancing the patient's safety risks is a problem that needs to be solved in clinical research.