Background: Definitive chemoradiotherapy is the standard of care for T4 and/or M1 lymph node cancers. Although the treatment strategy would depend mainly on the diagnosis of T4 disease, the diagnosis of T disease is not standardized and cases of borderline resectable T4 disease are often encountered. We have administered the triplet regimen as intensive chemotherapy for cases of borderline resectable T4 disease. Methods: We reviewed the records of patients with esophageal cancer who were treated between August 2009 and August 2010 at the Tochigi Cancer Center. Our treatment strategy for clinical stage II/III disease with unequivocal T4 disease in an adjacent organ was definitive chemoradiotherapy. Cases of clinical stage II/III disease with borderline resectable T4 disease were treated with preoperative chemotherapy via the triplet regimen of docetaxel and cisplatin plus 5-fluorouracil (DCF) followed by esophagectomy. Results: Nine patients were treated with preoperative chemotherapy. Six patients with defined borderline T4 disease were treated with DCF. DCF toxicities were tolerable and all patients underwent subsequent surgery. The R0 resection rate was 66 % (4/6), although pathological T4 disease was found in 50 % of patients (3/6). There were no major complications or mortality, although the median blood loss and operation time were relatively higher with this regimen. Although 5 patients died of recurrence or coexisting disease, oral intake was maintained at the terminal stage. Conclusion: Preoperative DCF followed by surgery seems to be a good option for select patients with T4 disease. Further investigations are warranted and a well-designed prospective trial is needed to draw a conclusion.
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