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September 10, 2025

Multidisciplinary Treatment Strategy for Clinical Stage Iv Esophageal Cancer Including Cf + Ici Therapy and Conversion Surgery

Key Points

Combination therapy with immune check inhibitors showed a 1-year survival rate of 72.3% in non-cT4/cM1b patients.
Among 56 patients, conversion surgery was conducted in 14.3%, reflecting its potential role in treatment plans.
Multidisciplinary treatment strategies, including chemoradiation, may enhance long-term outcomes in clinical stage IVA esophageal cancer.
The study highlights the need for further evaluation in stage IVB, where systemic disease treatment shows limited efficacy.

Abstract

Abstract Background The prognosis of clinical stage IV esophageal cancer is extremely poor, but with the advent of immune check inhibitors (ICIs), long-term survival can be expected in some cases. However, their long-term outcomes are still unsatisfactory. Therefore, in addition to ICI therapy, which has become the current standard of therapy, multidisciplinary treatment with radiation therapy for local control and conversion surgery are expected to contribute to long-term survival, but the optimal treatment strategy has not been established. We retrospectively reviewed the treatment strategy for clinical stage IVA/IVB esophageal cancer at our hospital and its survival benefit and tolerability. Methods Of 83 patients treated with CF + ICI therapy for advanced or recurrent esophageal cancer by September 2024 at our hospital, 56 patients with first clinical stage IVA/IVB esophageal cancer were included. Results The 1-year survival rates were 63.6%, 72.3%, and 45.8% in 15 patients with cT4/non-M1b, 28 patients with non-cT4/cM1b, and 13 patients with cT4/cM1b, respectively. CR with treatment response was 5 cases (8.9%), including 3 cases of cT4/non-M1b, 1 case of non-cT4/cM1b, and 1 case of cT4/cM1b. Conversion surgery was performed in 8 patients (14.3%), including 2 in stage IVA and 6 in stage IVB. 2 patients in stage IVA are still under observation without treatment. 3 of 6 patients in stage IVB are alive without recurrence, and 3 patients had recurrence, and all of them died of the original disease. Conclusion Combination therapy with ICI has enabled us to expect long-term survival of patients with clinical stage IV esophageal cancer, which had a poor prognosis in the past. Especially in stage IVA, multidisciplinary treatment including ICI, chemoradiation, and conversion surgery is expected to improve the long-term outcome. On the other hand, in stage IVB, which is a systemic disease, the same approach may be the key to long-term survival in some cases, although the therapeutic effect of this approach may be limited.

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