Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Aug;4(8):E841-8.
doi: 10.1055/s-0042-109609. Epub 2016 Aug 9.

Prognostic factors for salvage endoscopic resection for esophageal squamous cell carcinoma after chemoradiotherapy or radiotherapy alone

Shinya Kondo  1 , Masahiro Tajika  2 , Tsutomu Tanaka  2 , Takeshi Kodaira  3 , Nobumasa Mizuno  4 , Kazuo Hara  4 , Susumu Hijioka  4 , Hiroshi Imaoka  4 , Hidemi Goto  5 , Kenji Yamao  4 , Yasumasa Niwa  2
Affiliations

Prognostic factors for salvage endoscopic resection for esophageal squamous cell carcinoma after chemoradiotherapy or radiotherapy alone

Shinya Kondo et al. Endosc Int Open. 2016 Aug.

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None

Figures

Fig. 1
Fig. 1
Salvage endoscopic mucosal resection using a cap (EMR-C) for locoregional recurrence after chemoradiotherapy. a Endoscopy after iodine staining shows a circumferential, slightly depressed lesion in the lower thoracic esophagus. b Complete response is achieved after chemoradiotherapy. c Twenty-four months after chemoradiotherapy, locoregional recurrence occurs on the same site. d The lesion aspirated into the cap is strangulated by a snare. e The lesion is resected. f Iodaine staining is performed to check for a residual lesion.
Fig. 2
Fig. 2
Representative flow chart of the patient sample assessed in this study. CRT, chemoradiotherapy; ER, endoscopic resection; RT, radiotherapy; APC, argon plasma coagulation; CTx, chemotherapy; BSC, best supportive care.
Fig. 3
Fig. 3
Clinical course of patients after salvage endoscopic resection (n = 37). Primary, died of primary esophageal cancer; others, died of other disease. CRT, chemoradiotherapy; ER, endoscopic resection; CTx, chemotherapy; BSC, best supportive care.
Fig. 4
Fig. 4
Overall survival curve for the 37 patients who underwent salvage endoscopic resection.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

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. - PubMed
    1. 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. - PubMed
    1. 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. - PubMed
    1. 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. - PubMed
    1. 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. - PubMed