Curative-Intended Management of Synchronous Esophageal and Rectal Cancer-A Systematic Literature Review.

Purpose: Synchronous esophageal (EC) and rectal carcinoma (RC) is a rare and challenging condition, particularly in curative-intended treatment. Especially locally advanced tumors may not be suitable for primary resection and require individual multimodal treatment. This review examines curative-intended management of synchronous EC and RC.

Material and methods: A systematic literature search across five electronic databases according to the PRISMA guideline was conducted. Individual patient data was analyzed, including two additional cases from our institution.

Results: We identified 9 relevant cases from 1552 results. Additionally, two male patients (62 and 65 years old) from our institution were included. Both received 5-fluorouracil/cisplatin-based chemoradiotherapy (CRT) for EC. Sequential short-course radiation (SCRT) for RC was performed in one patient. After complete response (CR) in both tumors, no consecutive surgery was performed. He underwent resection for local recurrence of RC 11 months later and is currently considered as disease-free (30 months follow-up). The second patient underwent primary resection of RC and had early progression following resection of EC. We found that most patients had advanced EC (8/11), with the majority receiving neoadjuvant (5/11) or definitive treatment (3/11). Locally advanced RC was diagnosed in 5/11 patients, primarily treated with sequential resection. Pyrimidine-based systemic treatment was common. Four relapses and two deaths were reported, but median follow-up was 11 (range 1.5-30) months only.

Conclusion: The review suggests that neoadjuvant multimodal approaches may offer curative potential for synchronous EC and RC, with individualized treatment protocols adapted from single-cancer protocols. Nevertheless, data on long-term outcome is limited.