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Observational Study
. 2025 Jan;32(1):274-283.
doi: 10.1245/s10434-024-16196-7. Epub 2024 Sep 12.

Safety and Efficacy of Conversion Therapy After Systemic Chemotherapy in Advanced Esophageal Cancer with Distant Metastases: A Multicenter Retrospective Observational Study

Takayuki Tsuji  1 , Satoru Matsuda  2 , Yuta Sato  3 , Koji Tanaka  4 , Ken Sasaki  5 , Masaya Watanabe  6 , Yoichi Hamai  7 , Motomi Nasu  8 , Zenichiro Saze  9 , Yuichiro Nakashima  10 , Motoo Nomura  11 , Shun Yamamoto  12 , Eisuke Booka  13 , Koshiro Ishiyama  14 , Takeo Bamba  15 , Katsuyuki Sakanaka  16 , Takahiro Tsushima  17 , Hiroya Takeuchi  13 , Ken Kato  12 , Hirofumi Kawakubo  1
Affiliations
Observational Study

Safety and Efficacy of Conversion Therapy After Systemic Chemotherapy in Advanced Esophageal Cancer with Distant Metastases: A Multicenter Retrospective Observational Study

Takayuki Tsuji et al. Ann Surg Oncol. 2025 Jan.

Abstract

Background: Patients with esophageal squamous cell carcinoma (ESCC) with distant metastasis were treated with systemic chemotherapy. Recent advances in multimodal treatments have made conversion therapy a viable option for patients with incurable ESCC.

Objective: We aimed to assess the safety and efficacy of conversion therapy for ESCC with distant metastases.

Methods: Conversion therapy was defined as surgery or chemoradiotherapy (CRT) used to cure tumors that were previously considered incurable because of distant metastasis. We conducted a retrospective review of patients who underwent ESCC conversion therapy and assessed the treatment outcomes, including adverse events and survival rates.

Results: A total of 147 patients from 22 institutions were included. Systemic chemotherapy was initially administered to all patients. The most common M1 factor was the para-aortic lymph node, accounting for 55% of cases. Following the initial treatment, 116 patients underwent surgery, with 31 receiving CRT as conversion therapy. Postoperative complications in surgery patients included pneumonia (16%), anastomotic leakage (7%), and recurrent laryngeal nerve palsy (6%). During CRT, 18% of patients developed grade 3 or higher non-hematological toxicities. The 5-year overall survival (OS) rate was 31.7%. Pathological responders had significantly longer OS than non-responders (hazard ratio 0.493, p = 0.012). The distribution of distant metastasis, regimen type, clinical response, and conversion therapy modality did not have a significant impact on OS.

Conclusions: Conversion therapy can be safely performed for ESCC with distant metastasis and has a favorable prognosis.

Keywords: Chemotherapy; Conversion therapy; Distant metastasis; Esophageal cancer.

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Conflict of interest statement

Disclosure: Motoo Nomura has received honoraria from ONO, BMS, and MSD, and advisory board fees from ONO. Shun Yamamoto has received honoraria from ONO, BMS, MSD, and Taiho; advisory board fees from ONO; and expert testimony fees from Hokuto. Katsuyuki Sakanaka has received payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events from Novartis Pharma, and support for attending meetings and/or travel from MSD. Ken Kato reports funding, paid to the institution, from MSD, Ono Pharmaceuticals, BMS, Beigene, Shionogi, Merck Biopharma, Oncolys BioPharma, Daiichi Sankyo, Novartis, Taiho Pharmaceutical, Janssen, AstraZeneca, and Chugai. Takayuki Tsuji, Satoru Matsuda, Yuta Sato, Koji Tanaka, Ken Sasaki, Masaya Watanabe, Yoichi Hamai, Motomi Nasu, Zenichiro Saze, Yuichiro Nakashima, Eisuke Booka, Koshiro Ishiyama, Takeo Bamba, Takahiro Tsushima, Hiroya Takeuchi, and Hirofumi Kawakubo have no conflicts of interest to declare that may be relevant to the contents of this study.

References

    1. World Health Organization. GLOBOCAN Database. International Agency for Research on Cancer; 2020. Available at: https://gco.iarc.fr/ .
    1. Ministry of Health, Labour, and Welfare. Number and rate of deaths by sex by simple cause of death classification; 2020. Available at: https://www.mhlw.go.jp/toukei/list/81-1a.html .
    1. Moehler M, Maderer A, Thuss-Patience PC, Brenner B, Meiler J, Ettrich TJ, et al. Cisplatin and 5-fluorouracil with or without epidermal growth factor receptor inhibition panitumumab for patients with non-resectable, advanced or metastatic oesophageal squamous cell cancer: a prospective, open-label, randomised phase III AIO/EORTC trial (POWER). Ann Oncol. 2020;31:228–35. - DOI - PubMed
    1. Muro K, Lordick F, Tsushima T, Pentheroudakis G, Baba E, Lu Z, et al. Pan-Asian adapted ESMO Clinical Practice Guidelines for the management of patients with metastatic oesophageal cancer: a JSMO-ESMO initiative endorsed by CSCO, KSMO, MOS, SSO and TOS. Ann Oncol. 2019;30:34–43. - DOI - PubMed
    1. Sun JM, Shen L, Shah MA, Enzinger P, Adenis A, Doi T, et al. Pembrolizumab plus chemotherapy versus chemotherapy alone for first-line treatment of advanced oesophageal cancer (KEYNOTE-590): a randomised, placebo-controlled, phase 3 study. Lancet. 2021;398:759–71. - DOI - PubMed

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