Treatment and clinical outcome of clinical T4 esophageal cancer: A systematic review

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Survival of patients with <jats:styled-content style="fixed-case">cT</jats:styled-content>4 esophageal cancer is dismal. Although the optimal treatment strategy remains to be established, two treatment options are available for <jats:styled-content style="fixed-case">cT</jats:styled-content>4 esophageal cancers: definitive chemoradiation (<jats:styled-content style="fixed-case">dCRT</jats:styled-content>) and induction treatment followed by conversion surgery (<jats:styled-content style="fixed-case">CS</jats:styled-content>). However, little is known concerning the differences in clinical outcome between patients with T4 esophageal tumors treated with <jats:styled-content style="fixed-case">dCRT</jats:styled-content> and those eventually treated with CS.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A systematic search of the scientific literature on PubMed/<jats:styled-content style="fixed-case">MEDLINE</jats:styled-content> was carried out using the keywords “T4 esophageal cancer,” “invading (involving) adjacent organ,” “definitive chemoradiation,” “induction therapy,” “salvage surgery,” and “conversion surgery,” obtaining 28 reports published up to July 2018.</jats:p></jats:sec><jats:sec><jats:title>Results/Conclusion</jats:title><jats:p>We found that <jats:styled-content style="fixed-case">CS</jats:styled-content> was superior to <jats:styled-content style="fixed-case">dCRT</jats:styled-content> with respect to local disease control and short‐term survival; however, <jats:styled-content style="fixed-case">CS</jats:styled-content> was associated with relatively higher perioperative mortality and morbidity. Alternatively, although <jats:styled-content style="fixed-case">dCRT</jats:styled-content> might often cause fistula formation, a clinical complete response to <jats:styled-content style="fixed-case">dCRT</jats:styled-content> is likely to lead to a better prognosis. Recent advances in chemotherapeutic agents have led to triple induction chemotherapy, with docetaxel, cisplatin, and 5‐fluorouracil (<jats:styled-content style="fixed-case">DCF</jats:styled-content>), which has shown promise as an initial induction treatment for <jats:styled-content style="fixed-case">cT</jats:styled-content>4 esophageal cancer. Indeed, this regimen could control both local and systemic disease, which enables curative resection without preoperative <jats:styled-content style="fixed-case">CRT</jats:styled-content>. Moreover, some appropriate changes in perioperative management and intensive systemic chemotherapy might enhance patient outcome. Randomized controlled trials with a large sample size are needed to establish the standard treatment for <jats:styled-content style="fixed-case">cT</jats:styled-content>4 esophageal cancer.</jats:p></jats:sec>