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. 2015 Jan 31:10:31.
doi: 10.1186/s13014-015-0337-4.

The effectiveness of endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer

Gen Kawaguchi  1 , Ryuta Sasamoto  2 , Eisuke Abe  3 , Atsushi Ohta  4 , Hiraku Sato  5 , Kensuke Tanaka  6 , Katsuya Maruyama  7 , Motoki Kaizu  8 , Fumio Ayukawa  9 , Nobuko Yamana  10 , Junyang Liu  11 , Manabu Takeuchi  12 , Masaaki Kobayashi  13 , Hidefumi Aoyama  14
Affiliations

The effectiveness of endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer

Gen Kawaguchi et al. Radiat Oncol. .

Abstract

Background: To evaluate the risks and benefits of endoscopic submucosal dissection (ESD) in addition to chemoradiotherapy (CRT) for the treatment of superficial esophageal squamous cell carcinoma (SESCC).

Methods and materials: We retrospectively reviewed the treatment outcomes of 47 patients with SESCC treated between October 2000 and December 2011. Sixteen patients with invasion into the submucosal layer (T1b) or the muscularis mucosa (m3) with positive vascular invasion were treated with CRT after ESD (ESD-CRT group). The lymph node area was irradiated to a total dose of 40-44 Gy and a boost radiation was administered if PET-positive lymph nodes or positive margins were observed. The remaining 31 patients received definitive CRT only (dCRT group).

Results: The radiation field was significantly larger in the ESD-CRT group; the "long T" was used in 11 patients (35.4%) in the dCRT group and 15 (93.7%) in the ESD-CRT group (p = 0.0001). The total radiation dose was smaller in the ESD-CRT group; 40 Gy was used in 10 patients (62.5%) in the ESD-CRT group and all but one patient in the dCRT group received ≥60 Gy (p = 0.00001). The 3-year overall survival rates in the dCRT and ESD-CRT groups were 63.2% and 90.0% respectively (p = 0.118). Recurrence developed in nine patients (29.0%) in the dCRT group and one (6.3%) in the ESD-CRT group. Local recurrence was observed in six patients (19%) in the dCRT group and none in the ESD-CRT-group (p = 0.029). Pericardial effusion (≥Grade 3) occurred in three patients (9.7%) in the dCRT group and none in the ESD-CRT group.

Conclusions: ESD followed by CRT is an effective and safe approach for SESCC at m3 or T1b. This combination of ESD and CRT improves the local control rate, and it could decrease the number of cardiac toxicities due to a radiation-dose reduction relative to CRT alone.

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Figures

Figure 1
Figure 1
The overall survival rates of the ESD-CRT (n = 16) and dCRT (n = 31) patients. ESD-CRT: endoscopic submucosal dissection + chemoradiotherapy; dCRT: definitive chemoradiotherapy. The 3-year overall survival rate of the dCRT group (63.2%) was lower but not significantly different (p = 0.118) from that of the ESD-CRT group (90.0%).
Figure 2
Figure 2
Locoregional tumor control rates of the ESD-CRT and dCRT groups. The 3-year locoregional tumor control rates of the dCRT group (73.3%) was lower but not significantly different from that of the ESD-CRT group (92.3%; p = 0.152).
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References

    1. Tachimori Y, Ozawa S, Fujishiro M, Matsubara H, Numasaki H, Oyama T, et al. Comprehensive registry of esophageal cancer in Japan, 2006. Esophagus. 2014;11:21–47. doi: 10.1007/s10388-013-0393-5. - DOI - PMC - PubMed
    1. Griffin SM, Shaw IH, Dresner SM. Early complications after Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy: Risk factors and management. J Am Coll Surg. 2002;194:285–97. doi: 10.1016/S1072-7515(01)01177-2. - DOI - PubMed
    1. Tachibana M, Kinugasa S, Yoshimura H, Shibakita M, Tonomoto Y, Dhar DK, et al. Clinical outcomes of extended esophagectomy with three-field lymph node dissection for esophageal squamous cell carcinoma. Am J Surg. 2005;189:98–109. doi: 10.1016/j.amjsurg.2004.10.001. - DOI - PubMed
    1. Kato H, Sato A, Fukuda H, Kagami Y, Udagawa H, Togo A, 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;39:638–43. doi: 10.1093/jjco/hyp069. - DOI - PubMed
    1. Motoori M, Yano M, Ishihara R, Yamamoto S, Kawaguchi Y, Tanaka K, et al. Comparison between radical esophagectomy and definitive chemoradiotherapy in patients with clinical T1bN0M0 esophageal cancer. Ann Surg Oncol. 2012;19:2135–41. doi: 10.1245/s10434-012-2231-8. - DOI - PubMed

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