Endoscopic resection with adjuvant chemo-radiotherapy for superficial esophageal squamous cell carcinoma: A critical review

Background: Current guidelines recommend performing esophagectomy after endoscopic resection for early esophageal cancer when the risk of lymph node metastasis or residual cancer is found to be significant and endoscopic treatment is therefore noncurative. Our aim was to assess the safety and oncological outcomes of esophagogastric resection in this specific clinical setting. Patients and methods: A retrospective review from 2012 to 2018 was performed at four tertiary referral centers. All patients had a noncurative endoscopic resection of a clinical T1 esophageal cancer, followed by esophagectomy. Outcome measures were the rates of T0N0 specimens, overall survival, disease-free and cancer-specific survival, postoperative morbidity and mortality. Results: A total of 30 patients (13 with squamous cell carcinoma and 17 with adenocarcinoma) were included. The reasons for noncurative endoscopic resection were: positive vertical margins ( n = 12), squamous cell carcinoma with muscularis mucosae or submucosal layer invasion ( n = 3 and 9), adenocarcinoma with deep submucosal invasion ( n = 11), poorly differentiated tumor ( n = 6) and lymphovascular invasion ( n = 6). Overall, 63% of the esophagi were T0N0: most residual lesions were T1a metachronous lesions, and four (13%) patients had advanced pT status ( n = 3) or lymph node metastases ( n = 2). Overall survival, disease-free survival and cancer-specific survival were 83%, 75%, and 90% respectively. A total of 43% of patients had severe postoperative complications, and postoperative mortality was 7%. Conclusion: In this cohort, esophagectomy allowed the resection of residual advanced cancer or lymph node metastases in 13% of cases, at the cost of 43% severe morbidity and 7% mortality. Therefore, the possibility of close follow up needs to be balanced with a highly morbid surgical management in these patients.

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“…Furthermore, CRT seemed to be less toxic than surgery: indeed, no treatment-related death was reported in any of these studies. 42,44–48…”

Section: Discussionmentioning

confidence: 99%

Outcomes of esophagectomy after noncurative endoscopic resection of early esophageal cancer

Dermine

Leconte

Leblanc

et al. 2019

Therap Adv Gastroenterol

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“…It is unclear whether the addition of ER to RT/CRT for stage I ESCC can improve clinical outcomes [ 10 ]. In our study, ESD showed a close association with the LC rate; however, the relationship did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 99%

“…One of the main limitations of definitive CRT is local failure. Combined treatment involving ER and RT/CRT is considered as one of the treatment strategies for stage I ESCC patients with a high risk of recurrence [ 10 ]. The number of reports on the results of RT/CRT for stage I ESCC is limited, and furthermore, the necessity of elective nodal irradiation (ENI) and combined treatment involving endoscopic submucosal dissection (ESD) for stage I ESCC remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Radiotherapy for T1N0M0 Esophageal Cancer: Analyses of the Predictive Factors and the Role of Endoscopic Submucosal Dissection in the Local Control

Suzuki

Yamazaki

Aibe

et al. 2018

Cancers

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Several therapeutic options are available for clinical T1N0M0 thoracic esophageal squamous cell carcinoma (stage I ESCC); however, the studies on the treatment results are limited. This study assessed the outcomes of stage I ESCC treated with radiotherapy (RT), determined predictive factors, and evaluated the benefits of endoscopic submucosal dissection (ESD) combined with RT. We retrospectively analyzed the data of 50 patients (41 men, 9 women; median age, 66 years) with stage I ESCC treated with RT. The median total irradiation dose was 50 Gy. Elective nodal irradiation (ENI) was performed in 17 patients and ESD in 29 patients (ESD group). Forty-six patients concurrently received chemotherapy with RT. The median tumor length of ESD and non-ESD groups was 2.3 and 5 cm, respectively. The median follow-up was 33 months. The 3-year overall survival, disease-free survival (DFS), and local control (LC) rates were 77.3%, 61.1%, and 88.1%, respectively. Grade 3 adverse events occurred in 14 patients. T stage and tumor length were significant prognostic factors for 3-year DFS and 3-year LC, respectively. ESD appeared to be an important prognostic factor for LC. ENI and total irradiation dose above 50.4 Gy were not predictive factors. Our findings might help in treatment decisions for stage I ESCC.

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“…The authors concluded that CRT as an adjunct to high risk AC seems valid. More support for the efficacy and safety of endoscopic resection and adjuvant CRT comes from a recent review ( 19 ). Local recurrence was reported in 14% of the patients and could still be identified and successfully treated with salvage resection ( 20 ).…”

Section: Endoscopic Treatment For Early Ecmentioning

confidence: 99%

Current status of esophageal cancer treatment

Triantafyllou

Wijnhoven

2020

Chinese Journal of Cancer Research

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Esophageal cancer (EC) remains one of the most common and aggressive diseases worldwide. This review discusses some debates in the modern management of the disease. Endoscopic procedures for early cancer (T1a−b) are now embedded in routine care and the challenge will be to more accurately select patients for endoscopic resection with or without adjuvant therapy. Perioperative multimodal therapies are associated with improved survival compared to surgery alone for locally advanced esophageal cancer. However, there is no global consensus on the optimal regimen. Furthermore, histological subtype (adenocarcinoma vs . squamous cell cancer) plays a role in the choice for treatment. New studies are underway to resolve some issues. The extent of the lymphadenectomy during esophagectomy remains controversial especially after neoadjuvant chemoradiation. The ideal operation balances between limiting surgical trauma and optimizing survival. Minimally invasive esophagectomy and enhanced recovery pathways are associated with decreased morbidity and faster recovery albeit there is no consensus yet what approach should be used. Finally, immune checkpoint inhibitors present promising preliminary results in the novel treatment of advanced or metastatic EC but their widespread application in clinical practice is still awaited.

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Endoscopic resection with adjuvant chemo-radiotherapy for superficial esophageal squamous cell carcinoma: A critical review

Cited by 20 publications

References 21 publications

Outcomes of esophagectomy after noncurative endoscopic resection of early esophageal cancer

Outcomes of esophagectomy after noncurative endoscopic resection of early esophageal cancer

Radiotherapy for T1N0M0 Esophageal Cancer: Analyses of the Predictive Factors and the Role of Endoscopic Submucosal Dissection in the Local Control

Current status of esophageal cancer treatment

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