Advances and prospects of conversion surgery for unresectable esophageal squamous cell carcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

RAN Xingqiang , SHI Guidong , ZHOU Yu , YANG Hao , DING Hao ,  FU Maoyong

Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, P. R. China;

Corresponding author：

FU Maoyong, Email: fumaoyongmd@163.com

Keywords：

Esophageal squamous cell carcinoma; unresectable; conversion therapy; conversion surgery; review

DOI：

10.7507/1007-4848.202305052

Video：

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Esophageal squamous cell carcinoma can easily penetrate into the esophageal wall and invade adjacent organs due to the lack of serosa. Stage cT4b tumors involving organs adjacent to the aorta, vertebral body, trachea, or bronchus were considered unresectable. For unresectable esophageal squamous cell carcinoma, radical chemoradiotherapy or chemotherapy is recommended. However, the therapeutic effect is poor. With the advent of conversion surgery, surgical resection is feasible after induction therapy for patients with esophageal tumors that are initially unresectable due to adjacent organ invasion or distant metastasis. This article reviews the research on conversion surgery for unresectable esophageal squamous cell carcinoma in recent years in order to explore the clinical application prospects of conversion surgery.

Citation： RAN Xingqiang, SHI Guidong, ZHOU Yu, YANG Hao, DING Hao, FU Maoyong. Advances and prospects of conversion surgery for unresectable esophageal squamous cell carcinoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(7): 1050-1057. doi: 10.7507/1007-4848.202305052 Copy

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1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Arnold M, Ferlay J, van Berge Henegouwen MI, et al. Global burden of oesophageal and gastric cancer by histology and subsite in 2018. Gut, 2020, 69(9): 1564-1571.
3. Ajani JA, D'Amico TA, Bentrem DJ, et al. Esophageal and esophagogastric junction cancers, version 2. 2023, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2023, 21(4): 393-422.
4. Obermannová R, Alsina M, Cervantes A, et al. Oesophageal cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol, 2022, 33(10): 992-1004.
5. Ohtsu A, Boku N, Muro K, et al. Definitive chemoradiotherapy for T4 and/or M1 lymph node squamous cell carcinoma of the esophagus. J Clin Oncol, 1999, 17(9): 2915-2921.
6. Hara H, Tahara M, Daiko H, et al. Phase Ⅱ feasibility study of preoperative chemotherapy with docetaxel, cisplatin, and fluorouracil for esophageal squamous cell carcinoma. Cancer Sci, 2013, 104(11): 1455-1460.
7. Shinoda M, Ando N, Kato K, et al. Randomized study of low-dose versus standard-dose chemoradiotherapy for unresectable esophageal squamous cell carcinoma (JCOG0303). Cancer Sci, 2015, 106(4): 407-412.
8. Satake H, Tahara M, Mochizuki S, et al. A prospective, multicenter phase Ⅰ/Ⅱ study of induction chemotherapy with docetaxel, cisplatin and fluorouracil (DCF) followed by chemoradiotherapy in patients with unresectable locally advanced esophageal carcinoma. Cancer Chemother Pharmacol, 2016, 78(1): 91-99.
9. Matsuda S, Tsushima T, Kato K, et al. Defining conversion therapy for esophageal squamous cell carcinoma. Ann Gastroenterol Surg, 2022, 7(1): 7-9.
10. Yoshida K, Yasufuku I, Terashima M, et al. International retrospective cohort study of conversion therapy for stage Ⅳ gastric cancer 1 (CONVO-GC-1). Ann Gastroenterol Surg, 2021, 6(2): 227-240.
11. Chan WL, Choi CW, Wong IY, et al. Docetaxel, cisplatin, and 5-FU triplet therapy as conversion therapy for locoregionally advanced unresectable esophageal squamous cell carcinoma. Ann Surg Oncol, 2023, 30(2): 861-870.
12. Huang S, Wu H, Cheng C, et al. Conversion surgery following immunochemotherapy in initially unresectable locally advanced esophageal squamous cell carcinoma—A real-world multicenter study (RICE-Retro). Front Immunol, 2022, 13: 935374.
13. Zhang T, Guo Z, Chen X, et al. A retrospective study comparing definitive chemoradiotherapy vs. chemoradiotherapy followed by surgery in T4 esophageal squamous cell carcinoma patients who were downstaged after neochemoradiotherapy. Radiat Oncol, 2022, 17(1): 148.
14. Gao LR, Li C, Han W, et al. Survival benefit of surgery in patients with clinical T4 esophageal cancer who achieved complete or partial response after neoadjuvant chemoradiotherapy or radiotherapy. Ther Adv Med Oncol, 2022, 14: 17588359221108693.
15. Fan M, Dai L, Yan W, et al. Efficacy of programmed cell death protein 1 inhibitor in resection transformation treatment of esophageal cancer. Thorac Cancer, 2021, 12(15): 2182-2188.
16. Abe T, Higaki E, Hosoi T, et al. Long-term outcome of patients with locally advanced clinically unresectable esophageal cancer undergoing conversion surgery after induction chemotherapy with docetaxel plus cisplatin and 5-fluorouracil. Ann Surg Oncol, 2021, 28(2): 712-721.
17. Ohkura Y, Ueno M, Udagawa H. Advantageous factors of R0 curative conversion esophagectomy and the optimal extent of lymphadenectomy after induction therapy for cT4b thoracic esophageal cancer. Ann Gastroenterol Surg, 2020, 5(2): 204-214.
18. Sugimura K, Miyata H, Tanaka K, et al. Multicenter randomized phase 2 trial comparing chemoradiotherapy and docetaxel plus 5-fluorouracil and cisplatin chemotherapy as initial induction therapy for subsequent conversion surgery in patients with clinical T4b esophageal cancer: Short-term results. Ann Surg, 2021, 274(6): e465-e472.
19. Yokota T, Kato K, Hamamoto Y, et al. A 3-year overall survival update from a phase 2 study of chemoselection with DCF and subsequent conversion surgery for locally advanced unresectable esophageal cancer. Ann Surg Oncol, 2020, 27(2): 460-467.
20. Takeuchi M, Kawakubo H, Mayanagi S, et al. The benefits of docetaxel plus cisplatin and 5-fluorouracil induction therapy in conversion to curative treatment for locally advanced esophageal squamous cell carcinoma. World J Surg, 2019, 43(8): 2006-2015.
21. Miyata H, Sugimura K, Motoori M, et al. Clinical implications of conversion surgery after induction therapy for T4b thoracic esophageal squamous cell carcinoma. Ann Surg Oncol, 2019, 26(13): 4737-4743.
22. Tian D, Zhang L, Wang Y, et al. Neoadjuvant chemotherapy with irinotecan and nedaplatin in a single cycle followed by esophagectomy on cT4 resectable esophageal squamous cell carcinoma: A prospective nonrandomized trial for short-term outcomes. Dis Esophagus, 2019, 32(3): doy080.
23. Ishikawa K, Nakamatsu K, Shiraishi O, et al. Clinical results of definitive-dose (50 Gy/25 fractions) preoperative chemoradiotherapy for unresectable esophageal cancer. Int J Clin Oncol, 2015, 20(3): 531-537.
24. Shimoji H, Karimata H, Nagahama M, et al. Induction chemotherapy or chemoradiotherapy followed by radical esophagectomy for T4 esophageal cancer: Results of a prospective cohort study. World J Surg, 2013, 37(9): 2180-2188.
25. Pimiento JM, Weber J, Hoffe SE, et al. Outcomes associated with surgery for T4 esophageal cancer. Ann Surg Oncol, 2013, 20(8): 2706-2712.
26. Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol, 2012, 19(1): 68-74.
27. Kato K, Ito Y, Daiko H, et al. A randomized controlled phase Ⅲ trial comparing two chemotherapy regimen and chemoradiotherapy regimen as neoadjuvant treatment for locally advanced esophageal cancer, JCOG1109 NExT study. J Clin Oncol, 2022, 40: 238.
28. Yokota T, Hatooka S, Ura T, et al. Docetaxel plus 5-fluorouracil and cisplatin (DCF) induction chemotherapy for locally advanced borderline-resectable T4 esophageal cancer. Anticancer Res, 2011, 31(10): 3535-3541.
29. Yokota T, Kato K, Hamamoto Y, et al. Phase Ⅱ study of chemoselection with docetaxel plus cisplatin and 5-fluorouracil induction chemotherapy and subsequent conversion surgery for locally advanced unresectable oesophageal cancer. Br J Cancer, 2016, 115(11): 1328-1334.
30. Ishida K, Ando N, Yamamoto S, et al. Phase Ⅱ study of cisplatin and 5-fluorouracil with concurrent radiotherapy in advanced squamous cell carcinoma of the esophagus: A Japan Esophageal Oncology Group (JEOG)/Japan Clinical Oncology Group trial (JCOG9516). Jpn J Clin Oncol, 2004, 34(10): 615-619.
31. Terada M, Hara H, Daiko H, et al. Phase Ⅲ study of tri-modality combination therapy with induction docetaxel plus cisplatin and 5-fluorouracil versus definitive chemoradiotherapy for locally advanced unresectable squamous-cell carcinoma of the thoracic esophagus (JCOG1510: TRIANgLE). Jpn J Clin Oncol, 2019, 49(11): 1055-1060.
32. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med, 2012, 366(22): 2074-2084.
33. Shapiro J, van Lanschot JJB, Hulshof MCCM, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): Long-term results of a randomised controlled trial. Lancet Oncol, 2015, 16(9): 1090-1098.
34. Yang H, Liu H, Chen Y, et al. Neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of the esophagus (NEOCRTEC5010): A phase Ⅲ multicenter, randomized, open-label clinical trial. J Clin Oncol, 2018, 36(27): 2796-2803.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Advances and prospects of conversion surgery for unresectable esophageal squamous cell carcinoma

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