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

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发表日期：

2024年9月12日

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Takayuki Tsuji,
Satoru Matsuda,
Yuta Sato,
Koji Tanaka,
Ken Sasaki,
Masaya Watanabe,
Yoichi Hamai,
Motomi Nasu,
Zenichiro Saze,
Yuichiro Nakashima,
Motoo Nomura,
Shun Yamamoto,
Eisuke Booka,
Koshiro Ishiyama,
Takeo Bamba,
Katsuyuki Sakanaka,
Takahiro Tsushima,
Hiroya Takeuchi,
Ken Kato,
Hirofumi Kawakubo

摘要

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.