Nonsurgical treatments for submucosal esophageal squamous cell carcinomas

Abstract

Esophageal cancer is a disease with a poor prognosis. As with superfi cial esophageal cancers, lymph node metastases are seen rarely if the tumors are limited to the epithelium or lamina propria, but when cancers invade the submucosa, there is a high incidence of lymph node involvement. Surgery with radical lymph node dissection is a standard treatment for treating submucosal esophageal cancers. However, it is usually associated with a reduced level of quality of life for the patients, who are often elderly and have various medical complications making them unfi t for aggressive surgery. According to these background indications, various nonsurgical treatments have been developed to preserve the esophagus and to achieve a less invasive cure for such patients. Defi nitive radiotherapy could be a treatment option for patients with superfi cial carcinomas, particularly for those with mucosal cancers with an unresectable width by endoscopic mucosal resection (EMR). Although there have been some retrospective analyses with a small number of patients, they could not draw defi nitive conclusions. Defi nitive chemoradiotherapy has become one of the treatment options for patients who desire nonsurgical treatment. It has shown similar survival rates with those seen for radical surgery in two retrospective analyses and one multicenter prospective phase II study. The combination of primary EMR and prophylactic chemoradiotherapy has also shown promising results with less invasiveness than surgery. These nonsurgical approaches are now under evaluation in two multi-institutional studies run by the Japan Clinical Oncology Group (JCOG), which will clarify the optimal treatment for this disease.

Vascular endothelial growth factor C (VEGF-C) in esophageal cancer correlates with lymph node metastasis and poor patient prognosis

“…To avoid highly invasive surgery, EMR, ESD, chemoradiotherapy, and their combinations have been indicated for patients with early esophageal cancers. In the non-surgical treatment of early esophageal cancer, a high rate of local recurrence and lymph node metastasis is evident [ 24 ]. For non-surgical treatment, particularly ESD and EMR, preoperative diagnosis of lymph node metastasis is essential.…”