Objective: To assess the efficacy of preoperative chemoradiation therapy (CRT) for clinical T4 (cT4) esophageal cancer.

Materials and Methods: From November 1998 to November 2008, 57 patients with cT4 esophageal cancer (any N) without distant metastases underwent preoperative CRT. All but 2 patients received a total dose of 40 Gy administered in 20 fractions over 4 weeks. Eleven patients received 5-fluorouracil and cisplatin, and 46 were treated with docetaxel. All patients underwent reassessment of their response to CRT 1 month after completion of treatment. Surgery was performed within 4 to 6 weeks of completing CRT if the tumor was diagnosed as operable.

Results: One patient discontinued preoperative treatment at 30.6 Gy, and four stopped planned chemotherapy. One patient developed grade 4 thrombocytopenia, and six developed grade 3 leukocytopenia. One patient developed a grade 3 esophagobronchial fistula. Of the 57 patients, 36 (63%) were diagnosed with operable tumors and underwent curative intent surgery. A complete pathological response (grade 3, Japanese Classification of Esophageal Cancer The 11th edition) was achieved in 3 patients. The other responses were grade 2 (The number of proliferating cells is 1/3 or less) in 16 patients, grade 1a (Proliferable cells are 2/3 or more) in 6, grade 1b (Proliferable cells are 1/3 or more and less than 2/3) in 10, and unknown in 1. The 2-year overall survival rate was 21%. The 2-year survival rates for the curative intent surgery group and the inoperable group were 46% and 0%, respectively. In the surgery group, there was no significant difference in overall survival between patients who underwent R0 (no residual tumor) resection and those who underwent R1 (microscopic residual tumor) or R2 (macroscopic residual tumor) resection.

Conclusion: Preoperative CRT for cT4 esophageal cancer was relatively safe but did not improve overall survival (OS) compared to treatment solely with CRT.