Abstract
BACKGROUND: The role of consolidative thoracic radiotherapy in patients with metastatic esophageal cancer receiving chemotherapy combined with immunotherapy is unclear. This study aimed to evaluate the efficacy and safety of consolidative thoracic radiotherapy combined with chemotherapy and immunotherapy for metastatic esophageal cancer. METHODS: A multicenter retrospective study included 156 patients with metastatic esophageal cancer admitted between 2018 and 2023.Patients were divided into RT and non-RT groups based on whether they received consolidative thoracic radiotherapy. Propensity score matching (PSM) was used to reduce selection bias. Survival curves were compared using the log-rank test, and Kaplan-Meier survival curves were plotted. The primary endpoints were overall survival (OS) and progression-free survival (PFS). RESULTS: A total of 156 patients were reviewed, and 32 were matched in each group. After PSM, the median OS of the RT group was 38 months (95% CI 16.7–NA), while the median OS of the NRT group was 13.7 months (95% CI 9.0–NA) (95%CI 0.35–1.40) (HR: 0.7, p = 0.32). The median PFS in the RT group was not reached (95% CI 16.7–NA), and the median PFS in the NRT group was 9.3 months (95% CI 7.5–NA) (HR 0.62 95% CI 0.30–1.29, p = 0.17). The OS of the RT group was higher than that of the NRT group, although there was no statistical significance. Cox univariate and multivariate regression analysis showed that cervical tumor was an independent risk factor for OS and PFS (p < 0.05). The incidence of grade 1–2 pneumonia in the RT group was higher than that in the NRT group (p < 0.05), and there was no pneumonia of grade ≥ 3 in both groups. No treatment-related deaths occurred. CONCLUSION: Consolidative thoracic radiotherapy combined with chemoimmunotherapy is a viable and safe treatment option for metastatic esophageal cancer and should be further validated in larger trials. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12885-025-15118-4.