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Radiat Oncol. 2018 Dec 14;13(1):246. doi: 10.1186/s13014-018-1195-7.

Endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer: choice of new approach.

Author information

1
Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan. gensuzu@koto.kpu-m.ac.jp.
2
Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
3
Department of Digestive Surgery, Kyoto prefectural university Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
4
Department of Gastroenterology and Hepatology, Kyoto prefectural university Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.

Abstract

BACKGROUND:

The standard treatment for superficial esophageal cancer (SEC) involving muscularis mucosal (T1a-MM) or submucosal (T1b) invasion has been the surgical resection of the esophagus. However, esophagectomy with extended lymph node dissection is highly invasive. Recent reports have shown that endoscopic submucosal dissection (ESD) followed by chemoradiotherapy (CRT) has promising results and might become a new therapeutic approach. This retrospective study aimed to elucidate the efficacy and safety of this new treatment.

METHODS:

Patients with clinical stage T1b tumor without apparent metastasis treated with ESD followed by CRT from 2014 to 2017 (the CRT group) were included. The outcomes on disease-free survival (DFS) of this group were compared with those of consecutive patients in a historical control group who underwent ESD followed by esophagectomy (the esophagectomy group) between 2008 and 2015.

RESULTS:

Of 32 patients analyzed, 16 were in the CRT group and 16 with similar stage cancer were in the esophagectomy group. Radiotherapy was completed in all patients, and the incidence of grade ≥ 3 nonhematologic adverse events was 6%. The 2-year overall survival rates were 100%, and locoregional control was achieved in all patients in the CRT group, and the 2-year DFS rates were 88 and 100% for the CRT and esophagectomy groups, respectively, without significant differences.

CONCLUSIONS:

Our data confirmed our new approach as being safe and effective for locoregional control and may provide a nonsurgical treatment option for patients with clinical stage T1b tumors.

KEYWORDS:

Chemoradiotherapy; Endoscopic submucosal dissection; Esophagectomy; Superficial esophageal cancer; T1b

PMID:
30547811
PMCID:
PMC6295044
DOI:
10.1186/s13014-018-1195-7
[Indexed for MEDLINE]
Free PMC Article

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