Multimodal Treatment Linked to 3-Year Overall Survival in Esophageal Cancer

In this interim analysis, PFS rates were compared in PD-L1–defined biomarker subsets of patients receiving maintenance durvalumab or capecitabine.
In this interim analysis, PFS rates were compared in PD-L1–defined biomarker subsets of patients receiving maintenance durvalumab or capecitabine.
Researchers sought to determine the survival outcomes of patients with metastatic esophageal cancer who received multimodality treatment, including an operation.

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,
  • docetaxel,
  • cisplatin,
  • 5-FU.

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.”

Reference

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