Outcomes of multimodality therapy for stage IVB esophageal cancer with distant organ metastasis (M1-Org)

Abstract

Esophageal cancer patients with distant organ metastasis have usually been treated only to palliate symptoms without multimodality therapy. The current study evaluates the role of multimodality therapy in esophageal squamous cell cancer patients with distant organ metastasis. Between February 1988 and January 2007, 80 esophageal squamous cell cancer patients with distant organ metastases were treated at our institution. Multimodality therapy was performed in 58 patients: 43 patients received chemoradiotherapy, 13 underwent surgery followed by chemotherapy and/or radiation therapy, and two received chemotherapy or chemoradiotherapy followed by surgery. Thirteen patients received single-modality therapy; chemotherapy, radiotherapy, or surgery alone. The remaining nine patients received best supportive care alone. The metastatic organ was the liver (n= 40), the lungs (n= 33), bone (n= 10), and other (n= 6). Nine patients had metastasis in two organs. There was no difference in the median survival among the sites of organ metastasis, lung, liver, or bone (P= 0.8786). The survival of patients treated with multimodality therapy was significantly better than that of the patients who received single-modality therapy or best supportive care alone (P < 0.0001). In patients treated with multimodallity therapy, there was no difference in survival for patients treated with surgery compared with patients treated without surgery (P= 0.1291). This retrospective study involves an inevitable issue of patient selection bias. However, these results suggested that multimodality therapy could improve survival of the esophageal squamous cell cancer patients with distant organ metastasis.

Analysis of prognostic factors for esophageal squamous cell carcinoma with distant organ metastasis at initial diagnosis

“…This indicated that, on the basis of chemotherapy, the treatment of primary esophageal lesions may improve the survival of esophageal cancer patients with distant organ metastasis. 14 With regards to multimodality treatment, the difference in survival between surgery combined with chemotherapy and radiotherapy combined with chemotherapy was not statistically significant ( p ¼ 0.147), suggesting that either surgery or radiotherapy as a local treatment may be feasible for newly diagnosed distant organ metastasis from esophageal cancer. 15 However, due to the limited number of cases receiving multimodality treatment, our results require confirmation through the accumulation of more cases and further prospective clinical trials.…”

Palliative resection or radiation of primary tumor prolonged survival for metastatic esophageal cancer

“…Previous studies questioned the prognostic value of palliative resection of primary tumor. Tanaka et al investigated 80 metastatic esophageal squamous cell carcinoma patients, and found no difference in survival for palliative resection group and patients without resection . Saddoughi et al estimated 52 stage IV EC patients with palliative surgery in their institution.…”

Patterns of distant organ metastases in esophageal cancer: a population-based study

“…The prognosis of esophageal cancer patients is dismal, especially those with distant organ metastases (2). Poor outcomes in patients with esophageal cancer are related to the propensity for metastases, even when tumors are superficial (2,3) and lack of effective treatment modality for those with distant metastasis (4). However, there are few studies describing the patterns of distant metastasis in esophageal cancer systematically.…”