Combination of endoscopic submucosal dissection and chemoradiation therapy for superficial esophageal squamous cell carcinoma with submucosal invasion

Abstract

Abstract. The efficacy, safety and clinical outcomes of a combination of endoscopic submucosal dissection (ESD) with subsequent chemoradiation therapy (CRT) for superficial esophageal squamous cell carcinomas (superficial ESCC) remain unclear. We assessed the outcome of the combination of ESD plus CRT for superficial ESCC. Fourteen patients with superficial ESCC invading into the muscularis mucosa or submucosa were treated with ESD plus CRT from 2004 to 2010. En bloc resection of the lesion was successfully performed in all patients. The mean diameter of the lesions was 25 mm (range 10-55). The distribution of the depth of tumor invasion was to the muscularis mucosa in 8 patients, to the upper submucosal third (sm1) in 4 patients and to the middle submucosal third (sm2) in 2 patients. The laterally resected margins and vascular invasion were cancer-negative in all patients, but lymph node involvement was detected in 2 patients. The mean follow-up period after CRT was 45 months (range 19-70). No patients died of esophageal cancer. Recurrence or metastasis of the esophageal cancer was not observed in any of the patients. The combination of ESD plus CRT is effective for superficial ESCC.

Endoscopic Submucosal Dissection (ESD) with Additional Therapy for Superficial Esophageal Cancer with Submucosal Invasion

“…Seventeen patients (39.7%) decided to stay without any additional treatments due to the intolerance for further treatments or preference for minimized physical stress from the medical intervention. The rate of the patients who did not receive any additional treatments was higher than the rate of previous reports of 11-22% (15,19). One reason that we observed a higher rate may have been due to the age of the patients; the median age of these 17 patients was significantly older than the patients who received additional therapy.…”

“…There have been only a few studies focusing on the outcome of submucosal esophageal cancer treated by endoscopic resection followed by additional treatments (15)(16)(17).…”

Endoscopic submucosal dissection/endoscopic mucosal resection guidelines for esophageal cancer

“…The metastasis rates for each group were 12/216 (5.6%, 95% CI: 2.9–9.5%) in the follow‐up observation group (six reports; Table ), 0/6 in the additional surgical resection group (three reports; 0%, 95% CI: 0–46.0%), and 1/17 in the additional chemoradiotherapy group (six reports; 5.9%, 95% CI: 0.2–28.7%) (Table ).…”

“…Metastasis among patients with pSM1/SM2 cancer without vascular invasion occurred in 8/54 patients in the follow‐up observation group (six reports; 14.8%, 95% CI: 6.6–27.1%), 1/17 patients in the additional surgical resection group (six reports: 5.9%, 95% CI: 0.2–28.7%), and 9/121 patients in the additional chemoradiotherapy group (11 reports 7.4%, 95% CI: 3.5–13.7%) …”

“…The rates of treatment‐related death following surgical resection were 0–2.0% in four case‐series studies and 1.3% in a non‐RCT (1.3%, 95% CI: 0.7–2.2%). Delayed adverse events of additional chemoradiotherapy were tabulated from eight case‐series studies and one single‐arm prospective trial, with radiation pneumonitis grade ≥3 in 1.0% (3/302) of patients, grade 3 thromboembolism in 0.3% (1/302) of patients, and myocardial infarction grade ≥3 in 1.3% (4/302) of patients. A total of four treatment‐related deaths (4/302: 1.3%, 95% CI: 0.4–3.4%) were reported, comprising pneumonitis in one, sudden death in one, and myocardial infarction in two patients.…”