Multimodality treatment, including a surgical procedure, may be associated with 3-year overall survival in patients with metastatic esophageal cancer, according to a study in Cancers.
Researchers conducted a systematic review of published studies on surgical procedures in patients with synchronous metastatic esophageal cancer to assess the long-term outcomes of multimodal treatments. Researchers performed a literature search from January 2008 through December 2019 in Pubmed and Google Scholar for relevant prospective and retrospective studies, meta-analyses, and systematic reviews.
Of 36 studies identified, researchers included a total of 7 retrospective studies with 1756 patients undergoing an operation for stage IV esophageal cancer. Because only 2 comparative studies were identified, data compilation and relative risk assessment performed by a meta-analysis were not possible.
In 6 studies, patients received a neoadjuvant treatment involving chemotherapy, concordant radiochemotherapy, radiotherapy either alone (induction therapy), or as a consolidation. The chemotherapy agents that were used included:
- 5-fluorouracil (5-FU) and cisplatin,
- folinic acid protocol,
- 5-FU + oxaliplatin or cisplatin ± paclitaxel,
- fluoropyrimidines IV orally alone or in combination with platinum salt and taxane,
- cisplatin and 5-FU or carboplatin and paclitaxel,
The surgical approach was mostly conventional, with 1 minimally invasive procedure identified.
The median follow-up was 9 to 22 months. Patients had a median survival of 12.3 months, which was achieved in 6 studies. The overall 3-year survival rate was 23% (CI 95%, 17%-31%). All studies demonstrated a favorable effect on operation. Heterogeneity indicated I2=77%. After 1 study was omitted, heterogeneity decreased to I2=60%, which was considered moderate.
The 5-year overall survival rates were reported in 5 studies, with a median of 11% (5%-50%).
Study limitations include using only retrospective studies and only 2 comparable studies, a lack of data from 2 studies that were designed using the SEER database, and high heterogeneity among studies.
“The ‘test of time’ in patients with good systemic responses might warrant a more aggressive ablative treatment of oligometastatic disease, even in upper gastrointestinal cancer,” the study authors commented. “However, given the strength of intensified chemo/radiotherapy regimens and the morbidity of surgical procedures, such as an esophagectomy and secondary lesions resection, the treatment of metastatic patients should be tailored and consistently viewed as a quality-of-life approach.”
Bardol T, Ferre L, Aouinti S, et al. Survival after multimodal treatment including surgery for metastatic esophageal cancer: a systematic review. Cancers. 2022;14(16):3956. doi:10.3390/cancers14163956