The prognosis of cT4 esophageal cancer is unfavorable. We have reported that prognostic factors of cT4 esophageal cancer is a R0 resection. In a prospective cohort study evaluating the efficacy of multimodal therapy consisting of induction triplet chemotherapy or chemoradiotherapy (CRT) and subsequent esophagectomy for marginally unresectable T4 esophageal cancer, 58 patients with the disease underwent 2 courses of 5 FU/doxorubicin/nedaplatin (FAN) chemotherapy, 3 courses of docetaxel/cisplatin/S1 (DCS) chemotherapy, or 40-66 Gy CRT as the induction therapy. The aim of the study was to evaluate the outcome of the 3 types of multimodal therapy in these patients, and to determine the adequate induction therapy for T4 esophageal cancer.
Of the 58 patients, 17, 29, and 12 underwent FAN chemotherapy (2002–2006), CRT (2006–2013), and DCS chemotherapy (2013 - ), respectively. The short- and long-term results were compared among these patients. In all patients, suspicious T4 site was the trachea, bronchus, or aorta with or without other additional structures.
Major response of tumor to the induction therapy was observed in 35%, 69%, and 92% of patients who underwent FAN chemotherapy, CRT, and DCS chemotherapy, respectively (p = 0.013). Although manageable in all cases, the toxicity grade 3 or higher occurred in 73% of patients undergoing DCS chemotherapy, whereas that was 49 % and 59% in patients undergoing FAN chemotherapy and CRT, respectively. R0 resection rate (64%) after DCS chemotherapy was comparable to that (69%) after CRT, whereas that was 47% in patients undergoing FAN therapy. Mortality/morbidity rates after esophagectomy were 20%/50%, 4.5%/77%, and 0%/75% in patients undergoing FAN chemotherapy, CRT, and DCS chemotherapy, respectively. The 5-year survival rate after R0 esophagectomy was 38% and 62% in patients who underwent FAN chemotherapy and CRT, respectively.
iDCS therapy for cT4 esophageal cancer, the response rate and R0 resection rate are both high, and therefore, good remote results are expected. In addition, it recognized the effect even after CRT, it is a promising induction therapy, which aims to actively R0 resection for cT4 esophageal cancer.
Clinical trial identification
All authors have declared no conflicts of interest.