Wurschi Georg W, Schneider Claus, Ernst Thomas, Helfritzsch Herry, Nowatschin Jens, Bitter Thomas, Freesmeyer Martin, Pietschmann Klaus, Römer Maximilian
Department of Radiotherapy and Radiation Oncology, Jena University Hospital, 07747, Jena, Germany.
Clinician Scientist Program, Interdisciplinary Center for Clinical Research (IZKF), Jena University Hospital, 07747, Jena, Germany.
J Gastrointest Cancer. 2025 Jan 13;56(1):41. doi: 10.1007/s12029-025-01170-7.
Synchronous esophageal (EC) and rectal carcinoma (RC) is a rare and challenging condition, particularly in curative-intended treatment. Especially locally advanced tumors may not be suitable for primary resection and require individual multimodal treatment. This review examines curative-intended management of synchronous EC and RC.
A systematic literature search across five electronic databases according to the PRISMA guideline was conducted. Individual patient data was analyzed, including two additional cases from our institution.
We identified 9 relevant cases from 1552 results. Additionally, two male patients (62 and 65 years old) from our institution were included. Both received 5-fluorouracil/cisplatin-based chemoradiotherapy (CRT) for EC. Sequential short-course radiation (SCRT) for RC was performed in one patient. After complete response (CR) in both tumors, no consecutive surgery was performed. He underwent resection for local recurrence of RC 11 months later and is currently considered as disease-free (30 months follow-up). The second patient underwent primary resection of RC and had early progression following resection of EC. We found that most patients had advanced EC (8/11), with the majority receiving neoadjuvant (5/11) or definitive treatment (3/11). Locally advanced RC was diagnosed in 5/11 patients, primarily treated with sequential resection. Pyrimidine-based systemic treatment was common. Four relapses and two deaths were reported, but median follow-up was 11 (range 1.5-30) months only.
The review suggests that neoadjuvant multimodal approaches may offer curative potential for synchronous EC and RC, with individualized treatment protocols adapted from single-cancer protocols. Nevertheless, data on long-term outcome is limited.
同步性食管癌（EC）和直肠癌（RC）是一种罕见且具有挑战性的疾病，尤其是在进行根治性治疗时。特别是局部晚期肿瘤可能不适合一期切除，需要个体化的多模式治疗。本综述探讨同步性EC和RC的根治性治疗管理。
根据PRISMA指南，在五个电子数据库中进行了系统的文献检索。分析了个体患者数据，包括来自我们机构的另外两例病例。
我们从1552个结果中确定了9例相关病例。此外，纳入了我们机构的两名男性患者（62岁和65岁）。两人均接受了以5-氟尿嘧啶/顺铂为基础的食管癌放化疗（CRT）。其中一名患者接受了直肠癌的序贯短程放疗（SCRT）。两个肿瘤均达到完全缓解（CR）后，未进行连续手术。他在11个月后因直肠癌局部复发接受了手术，目前被认为无疾病（随访30个月）。第二名患者接受了直肠癌一期切除，在食管癌切除后出现早期进展。我们发现大多数患者患有晚期食管癌（8/11），大多数接受了新辅助治疗（5/11）或确定性治疗（3/11）。5/11的患者被诊断为局部晚期直肠癌，主要接受序贯切除治疗。基于嘧啶的全身治疗很常见。报告了4例复发和2例死亡，但中位随访时间仅为11（范围1.5 - 30）个月。
该综述表明，新辅助多模式方法可能为同步性EC和RC提供治愈潜力，采用从单一癌症方案改编而来的个体化治疗方案。然而，关于长期结局的数据有限。
