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Conversion Therapy for cT4b and M1 Esophageal Squamous Cell Carcinoma: A Comprehensive Systematic Review
Eisuke Booka1, Hiroya Takeuchi1
1Department of Surgery Hamamatsu University School of Medicine Hamamatsu Japan.
Annals of Gastroenterological Surgery
|March 9, 2026
Summary
Conversion therapy offers durable survival for select esophageal squamous cell carcinoma patients with unresectable tumors (cT4b/M1). Immune checkpoint inhibitors expand eligibility for curative-intent surgery, improving outcomes.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Conversion therapy is emerging for initially unresectable esophageal squamous cell carcinoma (cT4b/M1).
- Existing data provides a foundation, but optimal strategies require further clarification.
Purpose of the Study:
- To systematically review survival outcomes and treatment strategies for conversion therapy in esophageal squamous cell carcinoma.
- To assess the role of immune checkpoint inhibitors in this patient population.
Main Methods:
- Systematic review of PubMed, Embase, and Cochrane Library (2010-2025).
- Included 15 studies reporting outcomes for cT4b or M1 esophageal squamous cell carcinoma treated with conversion therapy.
Main Results:
- Up to 51.6% 5-year overall survival with salvage/conversion surgery for cT4b, with 98.9% R0 resection rates.
- For M1, 5-year overall survival reached 31.7% with conversion surgery (87% R0 resection).
- Immune checkpoint inhibitors expand eligibility for curative-intent local therapy.
Conclusions:
- Conversion therapy can achieve durable survival in carefully selected esophageal squamous cell carcinoma patients.
- Multidisciplinary decision-making and treatment response are crucial for survival.
- Further prospective studies are needed to refine patient selection and standardize algorithms.
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