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Review
. 2018 Dec 13;3(2):169-180.
doi: 10.1002/ags3.12222. eCollection 2019 Mar.

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

Tomoki Makino  1 , Makoto Yamasaki  1 , Koji Tanaka  1 , Yasuhiro Miyazaki  1 , Tsuyoshi Takahashi  1 , Yukinori Kurokawa  1 , Masaaki Motoori  2 , Yutaka Kimura  3 , Kiyokazu Nakajima  1 , Masaki Mori  1 , Yuichiro Doki  1
Affiliations
Review

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

Tomoki Makino et al. Ann Gastroenterol Surg. .

Abstract

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.

Keywords: T4; conversion surgery; definitive chemoradiation; esophageal cancer; induction chemotherapy.

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Figures

Figure 1
Figure 1
Possible algorism of a treatment strategy for cT4 esophageal cancer. Different treatment strategies, including (A) definitive chemoradiation (CRT), potentially followed by salvage surgery, in the absence of a complete response (CR); or (B) induction treatments potentially followed by conversion surgery. BSC, best supportive care; DCF, docetaxel, cisplatin, and 5‐fluorouracil
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References

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