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DOI: 10.1055/s-0042-109609
Prognostic factors for salvage endoscopic resection for esophageal squamous cell carcinoma after chemoradiotherapy or radiotherapy alone
Publikationsverlauf
submitted12. Januar 2016
accepted after revision23. Mai 2016
Publikationsdatum:
09. August 2016 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00025476/201608/lookinside/thumbnails/504_10-1055-s-0042-109609-1.jpg)
Background and study aims: Endoscopic resection is one treatment option for residual or locally recurrent esophageal cancer after definitive chemoradiotherapy or radiotherapy alone. However, little is known about the clinical benefit of salvage endoscopic resection for these lesions. Therefore, the effectiveness and prognostic factors of salvage endoscopic resection were investigated.
Patients and methods: A total of 37 patients with esophageal squamous cell carcinoma (SCC) who underwent salvage endoscopic resection after definitive chemoradiotherapy or radiotherapy alone were reviewed. The method of salvage endoscopic resection was endoscopic mucosal resection using a cap (EMR-C), strip biopsy, or endoscopic submucosal dissection. The effectiveness and prognostic factors of salvage endoscopic resection were retrospectively analyzed.
Results: A total of 37 patients with 49 lesions underwent salvage endoscopic resection. Baseline clinical stages were I in 23 patients, II in 3 patients, III in 9 patients, and IV in 2 patients. The number of locoregional recurrences and residual lesions were 35 and 14, respectively. The curative en bloc resection rate was 53.1 % (26/49). The total incidence of complications was 18.9 % (7/37); all were successfully managed conservatively. The 3-year and 5-year overall survival rates were 72.9 % and 53.3 %, respectively, with a median follow-up period of 54 months. Baseline clinical T1 – 2 and N0 were significant factors for good prognosis in terms of overall survival on univariate analysis.
Conclusions: Salvage endoscopic resection, especially EMR-C, is a safe and feasible procedure to control residual or recurrent superficial esophageal SCC after definitive chemoradiotherapy or radiotherapy alone. The present results showed that baseline clinical T1 – 2 and N0 before chemoradiotherapy or radiotherapy were significant prognostic factors.
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References
- 1 Kato K, Muro K, Minashi K et al. Phase II study of chemoradiotherapy with 5-fluorouracil and cisplatin for stage II-III esophageal squamous cell carcinoma: JCOG trial (JCOG 9906). Int J Radiat Oncol Biol Phys 2011; 81: 684-690
- 2 Kato H, Sato A, Fukuda H et al. A phase II trial of chemoradiotherapy for stage I esophageal squamous cell carcinoma: Japan Clinical Oncology Group Study (JCOG9708). Jpn J Clin Oncol 2009; 39: 638-643
- 3 Ishida K, Ando N, Yamamoto S et al. Phase II study of cisplatin and 5-fluorouracil with concurrent radiotherapy in advanced squamous cell carcinoma of the esophagus: a Japan Esophageal Oncology Group (JEOG)/Japan Clinical Oncology Group trial (JCOG9516). Jpn J Clin Oncol 2004; 34: 615-619
- 4 Ishikawa H, Sakurai H, Tamaki Y et al. Radiation therapy alone for stage I (UICC T1N0M0) squamous cell carcinoma of the esophagus: indications for surgery or combined chemoradiotherapy. J Gastroenterol Hepatol 2006; 21: 1290-1296
- 5 Sai H, Mitsumori M, Araki N et al. Long-term results of definitive radiotherapy for stage I esophageal cancer. Int J Radiat Oncol Biol Phys 2005; 62: 1339-1344
- 6 Swisher SG, Wynn P, Putnam JB et al. Salvage esophagectomy for recurrent tumors after definitive chemotherapy and radiotherapy. J Thorac Cardiovasc Surg 2002; 123: 175-183
- 7 Nakamura T, Hayashi K, Ota M et al. Salvage esophagectomy after definitive chemotherapy and radiotherapy for advanced esophageal cancer. Am J Surg 2004; 188: 261-266
- 8 Tachimori Y. Role of salvage esophagectomy after definitive chemoradiotherapy. Gen Thorac Cardiovasc Surg 2009; 57: 71-78
- 9 Chao YK, Chan SC, Chang HK et al. Salvage surgery after failed chemoradiotherapy in squamous cell carcinoma of the esophagus. Eur J Surg Oncol 2009; 35: 289-294
- 10 Miyata H, Yamasaki M, Takiguchi S et al. Salvage esophagectomy after definitive chemoradiotherapy for thoracic esophageal cancer. J Surg Oncol 2009; 100: 442-446
- 11 Gardner-Thorpe J, Hardwick RH, Dwerryhouse SJ. Salvage oesophagectomy after local failure of definitive chemoradiotherapy. Br J Surg 2007; 94: 1059-1066
- 12 Tomimaru Y, Yano M, Takachi K et al. Factors affecting the prognosis of patients with esophageal cancer undergoing salvage surgery after definitive chemoradiotherapy. J Surg Oncol 2006; 93: 422-428
- 13 Saeki H, Morita M, Tsuda Y et al. Multimodal treatment strategy for clinical T3 thoracic esophageal cancer. Ann Surg Oncol 2013; 20: 4267-4273
- 14 Hattori S, Muto M, Ohtsu A et al. EMR as salvage treatment for patients with locoregional failure of definitive chemoradiotherapy for esophageal cancer. Gastrointest Endosc 2003; 58: 65-70
- 15 Yano T, Muto M, Hattori S et al. Long-term results of salvage endoscopic mucosal resection in patients with local failure after definitive chemoradiotherapy for esophageal squamous cell carcinoma. Endoscopy 2008; 40: 717-721
- 16 Saito Y, Takisawa H, Suzuki H et al. Endoscopic submucosal dissection of recurrent or residual superficial esophageal cancer after chemoradiotherapy. Gastrointest Endosc 2008; 67: 355-359
- 17 Takeuchi M, Kobayashi M, Hashimoto S et al. Salvage endoscopic submucosal dissection in patients with local failure after chemoradiotherapy for esophageal squamous cell carcinoma. Scand J Gastroenterol 2013; 48: 1095-1101
- 18 Koizumi S, Jin M, Matsuhashi T et al. Salvage endoscopic submucosal dissection for the esophagus-localized recurrence of esophageal squamous cell cancer after definitive chemoradiotherapy. Gastrointest Endosc 2014; 79: 348-353
- 19 Inoue H, Endo M, Takeshita K et al. A new simplified technique of endoscopic esophageal mucosal resection using a cap-fitted panendoscope (EMRC). Surg Endosc 1992; 6: 264-265
- 20 Fujishiro M, Yahagi N, Kakushima N et al. Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin Gastroenterol Hepatol 2006; 4: 688-694
- 21 Kuwano H, Nishimura Y, Oyama T et al. Guidelines for Diagnosis and Treatment of Carcinoma of the Esophagus April 2012 edited by the Japan Esophageal Society. Esophagus 2015; 12: 1-30
- 22 Kawai H, Niwa Y, Tajika M et al. Is endoscopic mucosal resection acceptable for Stage 0 or IA esophageal squamous cell carcinoma?. Nagoya Med J 2012; 52: 185-197
- 23 Yano T, Muto M, Minashi K et al. Long-term results of salvage photodynamic therapy for patients with local failure after chemoradiotherapy for esophageal squamous cell carcinoma. Endoscopy 2011; 43: 657-663
- 24 Tu CH, Muto M, Horimatsu T et al. Submucosal tumor appearance is a useful endoscopic predictor of early primary-site recurrence after definitive chemoradiotherapy for esophageal squamous cell carcinoma. Dis Esophagus 2011; 24: 274-278
- 25 Yano T, Muto M, Minashi K et al. Photodynamic therapy as salvage treatment for local failures after definitive chemoradiotherapy for esophageal cancer. Gastrointest Endosc 2005; 62: 31-36
- 26 Wolfsen HC, Hemminger LL. Salvage photodynamic therapy for persistent esophageal cancer after chemoradiation therapy. Photodiagnosis Photodyn Ther 2006; 3: 11-14
- 27 Griffin JM, Reed CE, Denlinger CE. Utility of restaging endoscopic ultrasound after neoadjuvant therapy for esophageal cancer. Ann Thorac Surg 2012; 93: 1855-1859 ; discussion 1860
- 28 Kalha I, Kaw M, Fukami N et al. The accuracy of endoscopic ultrasound for restaging esophageal carcinoma after chemoradiation therapy. Cancer 2004; 101: 940-947
- 29 Zhang X, Watson DI, Lally C et al. Endoscopic ultrasound for preoperative staging of esophageal carcinoma. Surg Endosc 2005; 19: 1618-1621
- 30 van Vliet EP, Heijenbrok-Kal MH, Hunink MG et al. Staging investigations for oesophageal cancer: a meta-analysis. Br J Cancer 2008; 98: 547-557
- 31 Karashima R, Watanabe M, Imamura Y et al. Advantages of FDG-PET/CT over CT alone in the preoperative assessment of lymph node metastasis in patients with esophageal cancer. Surg Today 2015; 45: 471-477
- 32 Okada M, Murakami T, Kumano S et al. Integrated FDG-PET/CT compared with intravenous contrast-enhanced CT for evaluation of metastatic regional lymph nodes in patients with resectable early stage esophageal cancer. Ann Nucl Med 2009; 23: 73-80
- 33 Yamashita T, Zeniya A, Ishii H et al. Endoscopic mucosal resection using a cap-fitted panendoscope and endoscopic submucosal dissection as optimal endoscopic procedures for superficial esophageal carcinoma. Surg Endosc 2011; 25: 2541-2546
- 34 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-854