DOES MULTIMODALITY TREATMENT IMPROVE SURVIVAL IN OLIGOMETASTATIC ESOPHAGEAL CANCER? A SYSTEMATIC REVIEW.
Damiano Gentile*, Salvatore Marano, Pietro Riva, Anna Da Roit, Silvia Basato, Carlo Castoro
Department of Upper Gastro-Intestinal Surgery, Humanitas Research Hospital, Rozzano, Milano, Italy
Background: Esophageal cancer (EC) is still considered an aggressive disease associated with a poor prognosis due to its early metastatic spread. The liver is the most common site for metastasis followed by lymph nodes, lung and brain. Surgery represents the preferred treatment for curable EC, however stage IVB EC has not been treated with curative intent until now. The multimodality treatment, consisting of chemotherapy (CHT), radiotherapy (RT) and surgery, is a well established treatment for locally advanced EC, however, the therapeutic approach for oligometastatic esophageal cancer (OEC) has changed significantly. Nowadays, surgery for OEC is often discussed in multidisciplinary tumor boards individually for each patient. The purpose of this study is to analyze the characteristics OEC, to evaluate the long-term survival of OEC patients who underwent the multimodality treatment including surgery and to compare it with OEC patients who underwent single-modality treatment, either palliative CHT, RT or loco-regional therapies.
Methods: A comprehensive systematic literature search was conducted using PubMed, EMBASE, Scopus and the Cochrane Library CENTRAL to identify relevant articles published between January 1998 and June 2019 analyzing the characteristics of liver, lymph node, lung and brain OEC and evaluating possible treatment methods and the long-term survival of OEC patients. No restriction was set for number, age or sex of the patients. The search was limited to articles in English.
Results: A total of 48 studies were analyzed, involving 1363 patients with liver, lymph node, lung and brain OEC. One thousand and thirty-one patients were affected by metachronous tumors (75.6%) with a mean disease-free interval of 14.6 months. All the studies included in the review reported how OEC patients were treated. Eight hundred and twenty-five patients underwent single-modality treatment (60.5%). Overall, in the liver and lymph node OEC groups, patients who underwent multimodality treatment have a significantly better long-term survival than patients who underwent single-modality treatment (liver OEC 5-year OS: 18.8% vs. 0%, p= 0.001; lymph node OEC 5-year OS: 22.5% vs. 8.8%, p= 0.001, respectively). However, in the lung and brain OEC groups, the long-term survival of patients who underwent multimodality treatment is not statistically different from those who underwent single-modality treatment (lung OEC 5-year OS: 30.1% vs. 33%, p= 0.280; brain OEC 3-year OS: 3% vs. 0%, p= 0.190, respectively).
Conclusion: In summary, patients with isolated metastases may represent a sub-group that may benefit from a multimodality approach including surgery. Surgical resection associated with peri-operative CHT/RT may offer a survival benefit and should be taken into consideration as a treatment option for properly selected liver and lymph node OEC patients.
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