Therapeutic effectiveness of chemoradiotherapy for carcinosarcoma of the esophagus: two case reports and a review of the literature

Abstract

Esophageal carcinosarcoma is an extremely rare tumor, and surgery is the mainstay of treatment. We report two patients with carcinosarcoma of the esophagus who received neoadjuvant chemoradiotherapy and underwent curative resection. Patient 1 was a 50-year-old man with a type 2 lesion in the upper thoracic esophagus; clinical stage was T3 or partial T4N1M0. After chemoradiotherapy the tumor and the lymph nodes become smaller, and subtotal esophagectomy was performed. Patient 2 was a 66-year-old man with a protruding lesion in the lower thoracic esophagus. Preoperative chemoradiotherapy was administered, and he had a partial response. However, surgery was postponed because of pneumonia; 11 months later, tumor enlargement was confi rmed and we then performed subtotal esophagectomy. The therapeutic role and effectiveness of both chemotherapy and radiotherapy remain unclear. We reviewed 26 previously reported cases of esophageal carcinosarcoma treated by chemotherapy, radiotherapy, or both. These fi ndings suggest that preoperative chemoradiotherapy may be effective for downstaging the primary tumor in patients with advanced esophageal carcinosarcoma.

The controversy of esophageal carcinosarcoma

“…Kobayashi et al [ 19 ] considered chemotherapy with 5-fluorouracil plus cisplatin seemed to be partially effective in ECS, and that patient who underwent neoadjuvant chemotherapy remained disease free for 5 years after surgery. Some studies considered that chemoradiotherapy was active against carcinosarcoma and could be considered as a therapeutic option whenever surgery was not feasible, the clinical response of these cases were PR (partial remission), CR (complete remission), or downstage in these reports; [ 15 , 20 , 21 ] nevertheless recurrences sometimes occurred hematogenous metastasis or outside the field of radiation. Due to the effective of chemoradiotherapy, the chemoradiotherapy seemed useful in carcinosarcoma of cervical esophagus to preserve the laryngeal function, while that alone could not be considered because of the tumoral volume and dysphagia.…”

“…[ 15 ] Thus, we recommend chemoradiotherapy associated with therapeutic endoscopy which could improve food intake is an interesting alternative to surgery for a patient with a large pedunculated esophageal tumor whenever surgery is not feasible. In previous studies, [ 20 , 21 ] the chemotherapy regimen mainly was 5-FU and CDDP, S-1, and 5-FU. In Wang's study, [ 4 ] the DP (docetaxel +cisplatin) regimen represented outstanding in not only neoadjuvant chemotherapy, but also recurrent treatment; especially in 1 case, the patient with supraclavicular lymph nodes metastasis (T3N1M1, stage IV) attained PR after concurrent chemoradiotherapy which was radiotherapy of 60 Gy and accompanied weekly docetaxel of 60 mg; then, 4 cycles of XELOX regimen (capecitabine + oxaliplatin) was given and the patient had CR, which lasted for 16.1 months; after tumor recurrence, CR was regained after the salvage treatment with 4 cycles of DP (docetaxel + cisplatin) regimen, which indicated that ECS may be partially sensitive to docetaxel combined with 5-fluorouracil or platinum-based chemotherapy.…”

Esophageal Carcinosarcoma with Basaloid Squamous Cell Carcinoma: A Case Report and Review of the Literature

“…We searched for English articles via PubMed published since 2000 containing the key terms "esophagus", "carcinosarcoma" and/or "spindle cell carcinoma". Fourteen cases were identified in which preoperative therapy were performed and are summarized in Table 2 (Zuiki et al 2009;Kobayashi et al 2010Kobayashi et al , 2015Kuo et al 2010;Katsuya et al 2017;Yoshimoto et al 2018). Five patients underwent chemoradiotherapy in which the dose of radiation ranged from 38 to 62Gy, and chemotherapy were per- Endoscopic finding: 1, protruding type; 3, ulcerative and infiltrative type; c, carcinomatous lesion; s, sarcomatous lesion; Cytokeratin, an epithelial marker; Vimentin, an epithelial-mesenchymal transition marker; -, Negative; ±, less than 10% positive cells; +, 10-25% positive cells; ++, 25-50% positive cells; +++, more than 50% positive cells; NA, not available; NP, not performed; EMT, epithelial-mesenchymal transition.…”

Metastatic esophageal carcinosarcoma comprising neuroendocrine carcinoma, squamous cell carcinoma, and sarcoma

“…Although the regimen of preoperative chemotherapy is not determined because of the rarity, the efficacy of chemoradiotherapy or the combination of docetaxel, cisplatin, and 5-fluorouracil is reported. [ 20 – 24 ] The prognosis of esophageal carcinosarcoma compared with esophageal carcinoma is still not consistent. Talbert et al [ 12 ] reported better prognosis for carcinosarcoma than for carcinoma, and reasoned that carcinosarcoma is more easily found in the early stage because of the growth pattern of protrusion into the lumen, resulting in a lower frequency of lymph node metastasis.…”