Makino Tomoki, Yamasaki Makoto, Tanaka Koji, Miyazaki Yasuhiro, Takahashi Tsuyoshi, Kurokawa Yukinori, Motoori Masaaki, Kimura Yutaka, Nakajima Kiyokazu, Mori Masaki, Doki Yuichiro
Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan.
Department of Surgery Osaka General Medical Center Osaka Japan.
Ann Gastroenterol Surg. 2018 Dec 13;3(2):169-180. doi: 10.1002/ags3.12222. eCollection 2019 Mar.
Survival of patients with cT4 esophageal cancer is dismal. Although the optimal treatment strategy remains to be established, two treatment options are available for cT4 esophageal cancers: definitive chemoradiation (dCRT) and induction treatment followed by conversion surgery (CS). However, little is known concerning the differences in clinical outcome between patients with T4 esophageal tumors treated with dCRT and those eventually treated with CS.
A systematic search of the scientific literature on PubMed/MEDLINE was carried out using the keywords "T4 esophageal cancer," "invading (involving) adjacent organ," "definitive chemoradiation," "induction therapy," "salvage surgery," and "conversion surgery," obtaining 28 reports published up to July 2018.
RESULTS/CONCLUSION: We found that CS was superior to dCRT with respect to local disease control and short-term survival; however, CS was associated with relatively higher perioperative mortality and morbidity. Alternatively, although dCRT might often cause fistula formation, a clinical complete response to dCRT is likely to lead to a better prognosis. Recent advances in chemotherapeutic agents have led to triple induction chemotherapy, with docetaxel, cisplatin, and 5-fluorouracil (DCF), which has shown promise as an initial induction treatment for cT4 esophageal cancer. Indeed, this regimen could control both local and systemic disease, which enables curative resection without preoperative CRT. Moreover, some appropriate changes in perioperative management and intensive systemic chemotherapy might enhance patient outcome. Randomized controlled trials with a large sample size are needed to establish the standard treatment for cT4 esophageal cancer.
cT4期食管癌患者的生存率很低。尽管最佳治疗策略仍有待确定，但cT4期食管癌有两种治疗选择：根治性放化疗（dCRT）和诱导治疗后行转化手术（CS）。然而，对于接受dCRT治疗的T4期食管肿瘤患者与最终接受CS治疗的患者在临床结局上的差异，人们了解甚少。
使用关键词“T4期食管癌”“侵犯（累及）相邻器官”“根治性放化疗”“诱导治疗”“挽救性手术”和“转化手术”在PubMed/MEDLINE上对科学文献进行系统检索，获得截至2018年7月发表的28篇报告。
结果/结论：我们发现，在局部疾病控制和短期生存方面，CS优于dCRT；然而，CS与相对较高的围手术期死亡率和发病率相关。另外，尽管dCRT常常会导致瘘管形成，但对dCRT的临床完全缓解可能会带来更好的预后。化疗药物的最新进展已导致采用多西他赛、顺铂和5-氟尿嘧啶（DCF）进行三联诱导化疗，这已显示出作为cT4期食管癌初始诱导治疗的前景。确实，该方案可以控制局部和全身疾病，从而能够在不进行术前放化疗的情况下进行根治性切除。此外，围手术期管理和强化全身化疗的一些适当改变可能会改善患者的结局。需要开展大样本量的随机对照试验来确立cT4期食管癌的标准治疗方法。
