Treatment of thoracic esophageal carcinoma invading adjacent structures.
T4 esophageal cancer is defined as the tumor invading adjacent structures, using tumor-node-metastasis (TNM) staging. For clinically T4 thoracic esophageal carcinoma, multimodality therapy, that is, neoadjuvant chemoradiotherapy (CRT) followed by surgery or definitive CRT, has generally been performed. However, the prognosis of patients with these tumors remains poor. Another strategy is needed to achieve curative treatment. In the present article, the treatment strategies employed to date are reviewed. Furthermore, the strategies for these malignancies are reassessed, based on our experiences. R1/2 and R0 resections are regarded as those with residual and no tumor after surgery. The present data show that patients who underwent R1/2 resection after neoadjuvant CRT experienced little survival benefit, while complete response (CR) cases after definitive CRT had comparatively better results. Therefore, curative surgery should not be attempted without down-staging, and definitive CRT should be the initial treatment. Then surgery is indicated for the eradication of residual cancer cells. Close surveillance is essential for early detection of relapse even after CR, because the operation will gradually become increasingly difficult due to post-CRT fibrosis. In conclusion, multimodality therapy consists of definitive CRT followed by R0 resection, which can be the treatment of choice for T4 esophageal carcinoma. These challenging treatments have the potential to constitute the most effective therapeutic strategy.
Seto
Yasuyuki
Y
Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo 135-8550, Japan. yasuyuki.seto@jfcr.or.jp
Chin
Keisho
K
Gomi
Kotaro
K
Kozuka
Takuyo
T
Fukuda
Takashi
T
Yamada
Kazuhiko
K
Matsubara
Toshiki
T
Tokunaga
Masanori
M
Kato
Yo
Y
Yafune
Akifumi
A
Yamaguchi
Toshiharu
T
D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D015996:Survival Rate; D013899:Thoracic Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents