Surgical strategies for treatment of clinical T4 esophageal cancer in Japan

Background. Thoracic endovascular aortic repair of an aortoesophageal fistula is an effective emergency treatment for patients with T4-esophageal cancer, as it prevents sudden death, and is a bridge to surgery. However, the course of unresectable malignant aortoesophageal fistula treated with thoracic endovascular aortic repair alone is not well-known. Case Presentation. We report a 67-year-old Japanese man with T4-esophageal cancer who experienced a chemoradiation-induced aortoesophageal fistula and was rescued with thoracic endovascular aortic repair. He recovered after the procedure and survived for 4 additional months with management of a mycotic aneurysm and secondary aortoesophageal fistula with the exposure of the stent graft into the esophagus. Thoracic endovascular aortic repair of aortoesophageal fistula with T4-esophageal cancer extended life for nearly an average of 4 months in the reported cases. As a postoperative complication, the exposure of the stent graft into the esophagus is rare but life-threatening; the esophageal stent insertion was effective. Conclusions. With postoperative management advances, thoracic endovascular aortic repair can improve survival and increase the quality of life of patients with T4-esophageal cancer.

Download Full-text

P1.15-08 Outcomes of T4 Esophageal Cancer Treated with Neoadjuvant Chemoradiation Followed by Surgery and Definitive Chemoradiation: A Meta-Analysis

Journal of Thoracic Oncology ◽

10.1016/j.jtho.2019.08.1221 ◽

2019 ◽

Vol 14 (10) ◽

pp. S583

Author(s):

C.C. Lee ◽

Y.Y. Soon ◽

J. Tey

Keyword(s):

Esophageal Cancer ◽

Meta Analysis ◽

Neoadjuvant Chemoradiation ◽

Definitive Chemoradiation ◽

T4 Esophageal Cancer

Download Full-text

Induction Chemotherapy or Chemoradiotherapy Followed by Radical Esophagectomy for T4 Esophageal Cancer: Results of a Prospective Cohort Study

World Journal of Surgery ◽

10.1007/s00268-013-2074-x ◽

2013 ◽

Vol 37 (9) ◽

pp. 2180-2188 ◽

Cited By ~ 22

Author(s):

Hideaki Shimoji ◽

Hiroyuki Karimata ◽

Masayoshi Nagahama ◽

Tadashi Nishimaki

Keyword(s):

Esophageal Cancer ◽

Cohort Study ◽

Induction Chemotherapy ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Radical Esophagectomy ◽

T4 Esophageal Cancer

Download Full-text

Clinical Outcomes of Radiotherapy in Elderly and Younger Patients with T4 Esophageal Cancer: A Retrospective Single-Center Analysis

10.21203/rs.3.rs-770008/v1 ◽

2021 ◽

Author(s):

Yosuke Takakusagi ◽

Kio Kano ◽

Satoshi Shima ◽

Keisuke Tsuchida ◽

Nobutaka Mizoguchi ◽

...

Keyword(s):

Esophageal Cancer ◽

Clinical Outcomes ◽

Complete Response ◽

The Elderly ◽

Elderly Group ◽

Cancer Center ◽

Esophageal Fistula ◽

Younger Patients ◽

Significant Difference ◽

T4 Esophageal Cancer

Abstract Background/AimThe standard of treatment for esophageal cancer with adjacent organ invasion (T4) has not been established. Radiotherapy (RT) is a treatment option, but its efficacy and safety in elderly patients remains unclear. We retrospectively analyzed the clinical outcomes of RT in elderly and younger patients with T4 esophageal cancer.Materials and MethodsSixty-nine patients with T4 esophageal cancer who underwent RT at the Kanagawa Cancer Center between January 2014 and November 2020 were included in this study. Patients aged ≥70 years were defined as the elderly group and those aged <70 years were defined as the younger group.The total dose of RT was set at 60 Gy in 30 fractions. Chemotherapy combined with 5-fluorouracil and cisplatin was administered concurrently with RT. The overall survival (OS) rate was estimated using the Kaplan–Meier method. Adverse events were assessed using the CTCAE v4.0. Clinical outcomes were compared between the elderly and younger groups.ResultsThe median survival time (MST) of the elderly group was 21.5 months, and the OS rates at 1, 3, and 5 years were 63.7%, 31.3%, and 15.6%, respectively. The MST of the younger group was 12.5 months, and the OS rates at 1, 3, and 5 years were 52.2%, 29.4%, and 29.4%, respectively. A significant difference in OS was not observed between the two groups (p = 0.767). Themultivariate analysis revealed thatthe complete response (CR) of the primary tumor and adjuvant chemotherapy (ACTx) were significant predictors of OS (p< 0.001 and<0.001, respectively). Regarding toxicity, the frequency of thrombocytopenia was significantly higher in the elderly group, whereas the frequency of esophageal fistula was significantly higher in the younger group (p = 0.012 and 0.022, respectively). Other toxicities were not significantly different between the two groups.ConclusionsOS was not significantly different between the elderly and younger groups. ACTx and CR were predictors of OS. The frequency of thrombocytopenia was higher in the elderly group and that of esophageal fistula was higher in the younger group. However, other toxicities were not significantly differentbetween the two groups.

Download Full-text

Outcomes associated with T4 esophageal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.130 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 130-130

Author(s):

K. Meredith ◽

J. Weber ◽

R. Shridhar ◽

S. E. Hoffe ◽

K. Almhanna ◽

...

Keyword(s):

Esophageal Cancer ◽

Neoadjuvant Therapy ◽

Locally Advanced ◽

Survival Rates ◽

Disease Free Survival ◽

Pathologic Response ◽

Additional Patient ◽

Free Survival ◽

T4 Esophageal Cancer ◽

Disease Free

130 Background: Esophageal cancer often presents as locally advanced disease with 15% of patients having T4 tumors upon diagnosis. Esophagectomy was often reserved for palliation given the dismal survival rates and high rates of R1/R2 resections. However, neoadjuvant therapy (NT) has the potential to significantly downstage esophageal cancers and thus increase complete resection rates. We report our experience with surgically resected T4 cancers of the esophagus. Methods: Using a comprehensive esophageal cancer database, we identified patients who underwent an esophagectomy for T4 tumors between 1994 and 2008. Neoadjuvant therapy and pathologic response were recorded and denoted as complete (pCR), partial (pPR), and non-response (NR). Clinical and pathologic data were compared using Fisher's exact and chi-square when appropriate while Kaplan Meier estimates were used for survival analysis. Results: We identified 39 patients with T4 tumors who underwent esophagectomy of which 38 (97%) underwent NT. The median age was 61 (31-79) years with a median follow-up of 32 (5-97) months. There were 3 (7.9%) pCR, 17 (44.7%) pPR, and 18 (47.4%) NR. R0 resections were accomplished in 37 (94.9%). Two patients had incomplete resections. One patient had a R2 resection after NT and was deemed as NR. An additional patient had a R1 resection after NT and was a pPR with a residual 0.2 cm tumor on permanent pathology. There were 14 (35.9%) recurrences with a median time to recurrence of 19.5 (4-71) months. Complete pathologic response represented 1 (7.1%), whereas pPR and NR represented 6 (42.9%), and 7 (50%) respectively of all recurrences. The overall and disease free survival for all patients with T4 tumors was 28% and 34% respectively. Patients achieving a pCR had a 5-year overall and disease free survival of (43% and 47%), compared to pPR (30% and 21%) while there were no 5-year survivors in the NR cohort. Conclusions: T4 esophageal cancer often portends a dismal prognosis even after surgical resection. Historical incomplete resections and dismal survival rates often make surgery palliative rather then curative. However, we have demonstrated that neoadjuvant therapy and down staging of T4 tumors leads to increased R0 resections and improvements in overall and disease free survival. No significant financial relationships to disclose.

Download Full-text