Comparison of chemotherapy plus PD-1 inhibitor with chemoradiotherapy for metastatic ESCC patients with severe dysphagia.

318 Background: Dysphagia is a common symptom in patients (pts) with metastatic esophageal squamous cell carcinoma (ESCC). Guidelines recommend radiotherapy or palliative chemoradiotherapy (pCRT) for pts with metastatic ESCC harboring dysphagia. On the other hand, fluorouracil plus cisplatin (FP) combined with PD-1 inhibitor is known to be highly effective against ESCC. The present study aimed to compare the efficacy and the safety of FP+ICI and pCRT in metastatic ESCC pts with severe dysphagia. Methods: We retrospectively reviewed 51 metastatic ESCC pts with severe dysphagia treated with FP+ICI (n=33) or pCRT (n=18) between June 2018 and May 2025 in our institution. Severe dysphagia was defined as dysphagia score (DS) of 2 or higher. DS improved survival was defined as the period between DS improvement to ≤1 and DS worsened to ≥2 or survival event. Results: Patient characteristics in the FP+ICI group vs pCRT group were as follows: median age (range), 68 (41-80) vs 70.5 (59-79); gender male, 27 (82%) vs 15 (83%); ECOG PS 0/1-2, 22/11 vs 10/8; DS 2/3, 15/18 vs 10/8; cT stage 3/4, 18/15 vs 5/13; CPS status ≥10/