Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore; National University Hospital, Singapore, Singapore; National University Health System, Singapore, Singapore; National University of Singapore, Singapore, Singapore.
Acta Oncol. 2022 Jun;61(6):738-748. doi: 10.1080/0284186X.2022.2062680. Epub 2022 Apr 21.
The optimal treatment approach for T4 esophageal cancer is not well established. We aimed to perform a systematic review and meta-analysis to determine the survival rates and safety of chemoradiotherapy followed by surgery (CRT-S) and chemoradiotherapy alone (CRT) in patients with T4 N M0 esophageal cancer.
We searched databases for eligible prospective or retrospective studies. The outcomes of interest were overall survival (OS) at 1, 3 and 5 years, treatment-related fistula formation and mortality rates. Meta-analyses were performed using the random effects models separately for studies evaluating CRT-S and CRT. Subgroup analyses were performed based on histology, radiation dose, chemotherapy regimen and duration of the interval between CRT and surgery.
We identified 23 studies including 1,119 patients with predominantly squamous cell carcinoma (93%) and adenocarcinoma (3%) histology. The OS rates of patients receiving CRT-S were 65%, 36% and 20% at 1, 3 and 5 years, respectively. The OS rates of patients receiving CRT were 30%, 11% and 10% at 1, 3 and 5 years, respectively. Treatment-related fistula formation rates were 4% for CRT-S and 9% for CRT. Treatment-related mortality rates were 3% for both groups. Subgroup analyses showed that the interval of >2 months between CRT and surgery was associated with significantly improved OS rates at 1, 3 and 5 years.
Chemoradiotherapy is an efficacious treatment approach for T4 esophageal cancer, with clinically acceptable rates of treatment-related fistula formation and mortality. Tri-modality approach with surgery can be considered in carefully selected patients. Our study findings should be interpreted with caution due to the lack of high-quality evidence. Randomized controlled trials are warranted to confirm these findings.
T4 期食管癌的最佳治疗方法尚未确定。我们旨在进行系统评价和荟萃分析，以确定 T4N0M0 期食管癌患者接受放化疗后手术（CRT-S）和单纯放化疗（CRT）的生存率和安全性。
我们在数据库中搜索了符合条件的前瞻性或回顾性研究。主要结局为 1、3 和 5 年的总生存率（OS）、治疗相关瘘管形成和死亡率。分别使用随机效应模型对评估 CRT-S 和 CRT 的研究进行荟萃分析。根据组织学、放疗剂量、化疗方案以及 CRT 与手术之间的间隔时间进行亚组分析。
我们确定了 23 项研究，共纳入 1119 例患者，其中主要为鳞状细胞癌（93%）和腺癌（3%）组织学。接受 CRT-S 治疗的患者的 OS 率分别为 1、3 和 5 年时的 65%、36%和 20%。接受 CRT 治疗的患者的 OS 率分别为 1、3 和 5 年时的 30%、11%和 10%。CRT-S 的治疗相关瘘管形成率为 4%，CRT 为 9%。两组的治疗相关死亡率均为 3%。亚组分析显示，CRT 与手术之间的间隔>2 个月与 1、3 和 5 年时显著提高的 OS 率相关。
放化疗是 T4 期食管癌有效的治疗方法，治疗相关瘘管形成和死亡率可接受。对于精心选择的患者，可以考虑采用三联治疗方法联合手术。由于缺乏高质量的证据，我们的研究结果应谨慎解释。需要进行随机对照试验来证实这些发现。
