Oesophageal cancer metastases: An observational study of a more aggressive approach

Table 1 Clinical characteristics of patients

Patient	Age in yr	Sex	Primary tumour location	Histologic type of tumour	Differentiation	Clinical stage of primary tumour	Neoadjuvant therapy	Oesophagectomy	ypTNM
Synchronous and Metachronous Oligometastatic Disease
11	62	Female	Upper third	SCC	Moderate	T4N1M1	Walsh Regimen17	No	NA
22	53	Male	OGJ	AC	Poor	T3N2M1	Walsh Regimen + CROSS	Yes	T2bN1Mx
Synchronous Oligometastatic Disease Only
3	71	Male	Lower third/OGJ	AC	Poor	T3N1M1	Carbo5FU; 60Gy	Yes	T3N0M0
4	68	Male	OGJ	AC	Moderate-poor	T3N2M0	Walsh Regimen	Yes	T2N0Mx
Metachronous Oligometastatic Disease Only
5	56	Male	Middle/lower third	SCC	Moderate	T3N2M0	Walsh Regimen	Yes	T2N1Mx
6	36	Male	Lower	AC	Moderate	T3N1M0	CROSS	Yes	T3N0Mx
73	72	Female	OGJ	AC	Moderate	T3N0M0	CROSS	Yes	T2N0
8	70	Male	OGJ	AC	Poor	Nodal disease/Stage IIIA	MAGIC	Yes	T2N1Mx
9	48	Male	Lower third	AC	Poor	Stage IIB	Walsh Regimen	Yes	T1N0Mx
104	57	Male	Lower third	AC	Poor	T3N0M0	CROSS	Yes	T2N0M0
11	60	Male	OGJ	AC	Poor	T3N0M0	CROSS	Yes	T0N0Mx

¹Patient 1 had a complete clinical response.

²Patient 2 received six cycles of cisplatin and fluorouracil, followed by six cycles of paclitaxel and carboplatin.

³Patient 7 underwent salvage surgery after surveillance Positron-emission tomography suggested residual disease despite initial complete clinical response to neoadjuvant chemoradiotherapy.

⁴Patient 10 was diagnosed with a synchronous primary renal cell carcinoma, which was discovered incidentally during staging for his oesophageal cancer. He was referred to a urology service in another hospital and treated with radiofrequency ablation.

ypTNM: Pathologic staging after neoadjuvant therapy; Walsh Regimen¹⁷: Cisplatin/5-fluorouracil, 40 Gy concurrent radiotherapy; CROSS: The Dutch Chemoradiotherapy for Oesophageal Cancer Followed by Surgery study–weekly carboplatin and paclitaxel with concurrent radiotherapy; Carbo5FU: Carboplatin/5-fluorouracil; MAGIC: Epirubicin, cisplatin, and fluorouracil; NA: Not applicable; OGJ: Oesophagogastric junction; AC: Adenocarcinoma; SCC: Squamous cell carcinoma.

Table 2 Treatment of synchronous and metachronous oligometastatic oesophageal carcinoma

Patient	Synchronous metastases	Type	Treatment	Metachronous metastases	Type	Time to recurrence in mo	Treatment	Survival post recurrence in mo	Alive at study endpoint	Overall survival in mo
1	Yes	Locally advanced1	Walsh regimen	Yes	Lung	11.5	Stereotactic radiotherapy	36.4	No	47.9
2	Yes	Coeliac axis	Walsh regimen + CROSS + radial gastrectomy	Yes	Left para-aortic nodes	17.9	Chemotherapy (Epirubicin, Oxaliplatin + Capecitabine)	65.4	Yes	83.3
3	Yes	Liver	Carbo5FU; 60 Gy + oesophagectomy	No	NA	NA	NA	NA	No	23.6
4	Yes	Locally advanced2	Walsh regimen + oesophagectomy	No	NA	NA	NA	NA	Yes	102.8
5	No	NA	NA	Yes	Lung	32.9	Left upper lobectomy (VATS)	97.4	No	130.3
6	No	NA	NA	Yes	Lung	16.7	Chemotherapy (carbo/taxol + FOLFOX)	21.9	No	38.6
7	No	NA	NA	Yes	Lung	19.2	Wedge resection (VATS)	26.1	No	45.3
8	No	NA	NA	Yes	Adrenal	29.7	Adrenalectomy	62.1	Yes	91.8
9	No	NA	NA	Yes	Adrenal	15.9	Adrenalectomy + chemotherapy (irinotecan)	118.9	Yes	134.8
10	No	NA	NA	Yes	Liver	33.0	Resection + chemotherapy	51.9	Yes	84.9
11	No	NA	NA	Yes	Paraaortic + Retroperitoneal	15.7	Chemotherapy (FOLFOX)	14.9	Yes	30.6

¹Right innominate artery and pars membrane of the trachea with a right 1 cm subcarinal adenopathy and left 5 mm paratracheal node on staging whole-body positron emission tomography-computed tomography (squamous cell carcinoma, T4N1M1).

²1 cm fluorodeoxyglucose avid right supraclavicular node on staging positron emission tomography-computed tomography.

NA: Not applicable; VATS: Video-assisted thoracoscopic surgery; FOLFOX: Folinic acid, fluorouracil, oxaliplatin; CROSS: The Dutch Chemoradiotherapy for Oesophageal Cancer Followed by Surgery study–weekly carboplatin and paclitaxel with concurrent radiotherapy; Carbo5FU: Carboplatin/5-fluorouracil.