ASO Author Reflections: How Should the Patients with Locally Advanced Unresectable Esophageal Cancer Be Treated with Multidisciplinary Approach?

Excerpt

The standard of care for locally advanced unresectable esophageal squamous cell carcinoma (ESCC) due to tumor invasion of adjacent organs is definitive chemoradiotherapy (CRT).1,2 Because of an increased risk of major perioperative complications in esophagectomy after CRT, patients with clinical T4 disease have not been considered for surgery.4,5 Therefore, definitive CRT without planned esophagectomy is considered the standard treatment for locally advanced unresectable esophageal cancer.1‐4 However, survival of this disease remains unfavorable even after CRT. We conducted a multicenter, phase II trial (COSMOS study) to evaluate whether chemoselection with docetaxel plus cisplatin and 5-fluorouracil induction chemotherapy (DCF-ICT) and subsequent conversion surgery is safe and has survival benefits for initially unresectable locally advanced ESCC.5 The results showed that DCF-ICT is a sufficiently powerful preoperative treatment that results in a high rate of curative resection (39.6%). …