Treatment of T4 Esophageal Cancer. Definitive Chemo-Radiotherapy vs Chemo-Radiotherapy Followed by Surgery

Makino, Tomoki; Doki, Yuichiro

doi:10.5761/atcs.ra.11.01676

Cited by 42 publications

(21 citation statements)

References 43 publications

(103 reference statements)

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“…For T4 esophageal SCC, it is still unclear if the addition of surgery provided survival benefit in patients with compared with definite CCRT. Previous studies reported the effectiveness of definite CCRT in advanced esophageal cancer including T4 tumors4041. Although only 18% of T4 patients in our hospital received surgical resection, survival analysis showed that surgery with (neo-) adjuvant treatment offers a favorable overall survival compared with definite CCRT by uni- and multivariable analysis.…”

Section: Discussionmentioning

confidence: 67%

Survival benefit of surgery to patients with esophageal squamous cell carcinoma

Chen

et al. 2017

Sci Rep

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To assess if surgery provided survival benefit to patients with esophageal squamous cell carcinoma (SCC), we performed a retrospective review of 1230 patients who were newly diagnosed with stage T2-T4 esophageal SCC from 2007 to 2014 in our hospital. There were greater than 70% of patients with age under 65 years, and more than 85% were stage T3-T4 at the time of diagnosis. The median survival time was 1.06 year (95% CI 0.99–1.1 yrs). Survival analyses showed that survival time was significantly associated with age, T stage, clinical lymph node involvement and treatment modality (surgery versus definite chemoradiotherapy). Surgery still possessed a powerful impact on overall survival by multivariable analysis. Death risk of patients treated with curative surgery was significantly lower than those with definite chemoradiotherapy. Furthermore, for patients of stage T3N(+) and T4, surgery combined with (neo-)adjuvant treatment were significantly associated with higher survival rate than surgery alone or definite chemoradiotherapy. In conclusion, the patients who undergo surgery were significantly associated longer survival, therefore, curative resection should be considered for esophageal cancer patients who are medically fit for surgery. Moreover, combined with (neo-)adjuvant treatment is recommended for surgically resectable stage T3-T4 esophageal SCC.

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Section: Discussionmentioning

confidence: 67%

Survival benefit of surgery to patients with esophageal squamous cell carcinoma

Chen

et al. 2017

Sci Rep

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“…Despite advances in surgical techniques, T4 disease is usually considered inoperable. The current therapeutic options for locally advanced disease of this kind are chemoradiotherapy followed by surgery and definitive concurrent chemoradiotherapy (ccrt) 3 .…”

Section: Introductionmentioning

confidence: 99%

Involved-Field Irradiation in Definitive Chemoradiotherapy for T4 Squamous Cell Carcinoma of the Esophagus

Zhao

Zhang

et al. 2016

Current Oncology

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Objectives Definitive concurrent chemoradiotherapy (ccrt) is currently a therapeutic option for locally advanced esophageal cancer. However, clinical practice differs with respect to the target volume for irradiation. The purpose of the present study was to analyze failure patterns and survival, and to determine the feasibility of using involved-field irradiation (ifi) with concurrent chemotherapy for T4 squamous cell carcinoma (scc) of the esophagus.Methods Between January 2003 and January 2013, 56 patients with clinical T4M0 scc of the esophagus received ccrt using ifi. The radiation field included the primary tumour and clinically involved lymph nodes. Target volumes and sites of failure were analyzed, as were treatment-related toxicity and survival time.Results In this 56-patient cohort, 13 patients (23.2%) achieved a complete response, and 21 (37.5%) achieved a partial response, for a total response rate of 60.7%. The major toxicities experienced were leucocytopenia and esophagitis, with 14 patients (25.0%) experiencing grade 3 toxicities. At a median follow-up of 34 months, 48 patients (85.7%) had experienced failure: 39 (69.6%) in-field, 7 (12.5%) elective nodal, and 19 (33.9%) distant. Only 1 patient (1.8%) experienced isolated elective nodal failure. The 1-, 2-, and 3-year survival rates were 39.3%, 21.4%, and 12.5% respectively. ConclusionsFor patients with T4M0 scc of the esophagus, definitive ccrt using ifi resulted in an acceptable rate of isolated elective nodal failure and an overall survival comparable to that achieved with elective nodal irradiation. A limited radiation therapy target volume, including only clinically involved lesions, would therefore be a feasible choice for this patient subgroup.

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“…Esophageal cancers tend to invade adjacent organs, including the trachea, bronchus, lung, and aorta, as a result of the lack of serosa in the esophagus and the fact that this conduit is located in a very narrow mediastinal space . Tumors that invade adjacent organs are classified as T4, according to the TNM staging system of the International Union against Cancer (UICC).…”

Section: Introductionmentioning

confidence: 99%

Treatment and clinical outcome of clinical T4 esophageal cancer: A systematic review

Makino

Yamasaki

Miyazaki

et al. 2018

Annals of Gastroent Surgery

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Background Survival of patients with cT4 esophageal cancer is dismal. Although the optimal treatment strategy remains to be established, two treatment options are available for cT4 esophageal cancers: definitive chemoradiation (dCRT) and induction treatment followed by conversion surgery (CS). However, little is known concerning the differences in clinical outcome between patients with T4 esophageal tumors treated with dCRT and those eventually treated with CS. Methods A systematic search of the scientific literature on PubMed/MEDLINE was carried out using the keywords “T4 esophageal cancer,” “invading (involving) adjacent organ,” “definitive chemoradiation,” “induction therapy,” “salvage surgery,” and “conversion surgery,” obtaining 28 reports published up to July 2018. Results/Conclusion We found that CS was superior to dCRT with respect to local disease control and short‐term survival; however, CS was associated with relatively higher perioperative mortality and morbidity. Alternatively, although dCRT might often cause fistula formation, a clinical complete response to dCRT is likely to lead to a better prognosis. Recent advances in chemotherapeutic agents have led to triple induction chemotherapy, with docetaxel, cisplatin, and 5‐fluorouracil (DCF), which has shown promise as an initial induction treatment for cT4 esophageal cancer. Indeed, this regimen could control both local and systemic disease, which enables curative resection without preoperative CRT. Moreover, some appropriate changes in perioperative management and intensive systemic chemotherapy might enhance patient outcome. Randomized controlled trials with a large sample size are needed to establish the standard treatment for cT4 esophageal cancer.

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Treatment of T4 Esophageal Cancer. Definitive Chemo-Radiotherapy vs Chemo-Radiotherapy Followed by Surgery

Cited by 42 publications

References 43 publications

Survival benefit of surgery to patients with esophageal squamous cell carcinoma

Survival benefit of surgery to patients with esophageal squamous cell carcinoma

Involved-Field Irradiation in Definitive Chemoradiotherapy for T4 Squamous Cell Carcinoma of the Esophagus

Treatment and clinical outcome of clinical T4 esophageal cancer: A systematic review

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