Treatment Strategy for Cstage Iv Esophageal Cancer and the Significance of Conversion Surgery

Abstract Background First-line chemotherapy for cStage IV esophageal carcinoma results in poor outcomes. Compared with placebo plus chemotherapy, pembrolizumab plus chemotherapy improved overall survival in patients with previously untreated, advanced oesophageal squamous cell carcinoma according to the KEYNOTE-590. We studied 30 patients for the unresectable esophageal cancer and gastroesophageal junction adenocarcinoma cases treated with pembrolizumab and chemotherapy at our hospital. Methods To investigate the indications and efficacy of ICI therapy and CS for stage IV advanced esophageal cancer. The study included 30 patients with advanced carcinoma of the thoracic esophagus having either T4 tumor or distant lymph node metastasis were enrolled in this study between November 2023 and April 2025. Results Back ground: Averaged Age 67 (41–85), male:female =25:5, location (Ce:Ut:mt: Lt: Jz =1: 2: 11: 10: 6), strength 71 mm (30–120), Stage (IVA: IVB = 15:15), Pathology (SCC: AD = 27:3), Times (3 courses completed: uncompleted: ongoing = 22:5:2), Response CR: PR:SD:PD =2:9:10:9, Toxicity: irAE: liver dysfunction: Febrile neutropenia = 5:5:6, The incidence of Grade 3 or higher adverse events was 6/30. One toxicity-related death occurred. After chemotherapy: operation: radiation: observation: death:=7:9:2:12. We performed conversive esophagectomy for 7 patients. T4a: T4b = 6: 1, R0:R1: R2 = 5: 1: 1. Conclusion Back ground: Averaged Age 67 (41–85), male:female =25:5, location (Ce:Ut:mt: Lt: Jz =1: 2: 11: 10: 6), strength 71 mm (30–120), Stage (IVA: IVB = 15:15), Pathology (SCC: AD = 27:3), Times (3 courses completed: uncompleted: ongoing = 22:5:2), Response CR: PR:SD:PD =2:9:10:9, Toxicity: irAE: liver dysfunction: Febrile neutropenia = 5:5:6, The incidence of Grade 3 or higher adverse events was 6/30. One toxicity-related death occurred. After chemotherapy: operation: radiation: observation: death:=7:9:2:12. We performed conversive esophagectomy for 7 patients. T4a: T4b = 6: 1, R0:R1: R2 = 5:1: 1.