Long-term outcomes of patients with recurrent squamous cell carcinoma of the esophagus undergoing salvage endoscopic resection after definitive chemoradiotherapy.
Adult
Aged
Biopsy
Chemoradiotherapy
Disease-Free Survival
Endoscopy
Esophageal Neoplasms
/ pathology
Esophageal Squamous Cell Carcinoma
/ mortality
Female
Follow-Up Studies
Humans
Male
Middle Aged
Multivariate Analysis
Neoplasm Recurrence, Local
/ pathology
Risk Factors
Salvage Therapy
Time Factors
Treatment Outcome
Definitive chemoradiotherapy
Endoscopic resection
Esophageal squamous cell carcinoma
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
received:
26
12
2019
accepted:
15
04
2020
pubmed:
2
5
2020
medline:
3
7
2021
entrez:
2
5
2020
Statut:
ppublish
Résumé
Salvage endoscopic resection (ER) has been reported to be effective for patients with local failure of esophageal squamous cell carcinoma (ESCC) after definitive chemoradiotherapy (dCRT). This study aimed to evaluate the long-term outcomes of salvage ER for patients with local failure of ESCC and to identify risk factors associated with disease recurrence after salvage ER. This study included 45 patients undergoing salvage ER after dCRT during 2000 to 2017. After ER, all patients were required to undergo surveillance esophagogastroduodenoscopy (EGD) once or twice every year, and a computed tomography (CT) examination was repeated every 3 to 6 months. We assessed short-term outcomes and long-term outcomes. Of the 45 patients in this study, the baseline clinical T stage before dCRT was T1 in 80%, 66% of the patients did not have nodal metastasis. The median time from CRT to the detection of local failure was 11 months (range 2-130 months). The en-bloc resection rate was 46%, and the R0 resection rate was 38%, respectively. Stricture occurred after salvage ER for one case, while adverse events such as bleeding or perforation and ER-related death did not occur. After a median observation period of 57 months, recurrence free survival at 3 years was 58%, overall survival was 72%, and disease specific survival was 81%. In multivariate analysis, clinical N stage before CRT was the only independent risk factor of recurrence after salvage ER (p = 0.04). Salvage ER might be effective local treatment in patients with local failure after dCRT. For the patients with clinical N stage, frequent surveillance should be performed.
Sections du résumé
BACKGROUND
Salvage endoscopic resection (ER) has been reported to be effective for patients with local failure of esophageal squamous cell carcinoma (ESCC) after definitive chemoradiotherapy (dCRT). This study aimed to evaluate the long-term outcomes of salvage ER for patients with local failure of ESCC and to identify risk factors associated with disease recurrence after salvage ER.
METHODS
This study included 45 patients undergoing salvage ER after dCRT during 2000 to 2017. After ER, all patients were required to undergo surveillance esophagogastroduodenoscopy (EGD) once or twice every year, and a computed tomography (CT) examination was repeated every 3 to 6 months. We assessed short-term outcomes and long-term outcomes.
RESULTS
Of the 45 patients in this study, the baseline clinical T stage before dCRT was T1 in 80%, 66% of the patients did not have nodal metastasis. The median time from CRT to the detection of local failure was 11 months (range 2-130 months). The en-bloc resection rate was 46%, and the R0 resection rate was 38%, respectively. Stricture occurred after salvage ER for one case, while adverse events such as bleeding or perforation and ER-related death did not occur. After a median observation period of 57 months, recurrence free survival at 3 years was 58%, overall survival was 72%, and disease specific survival was 81%. In multivariate analysis, clinical N stage before CRT was the only independent risk factor of recurrence after salvage ER (p = 0.04).
CONCLUSIONS
Salvage ER might be effective local treatment in patients with local failure after dCRT. For the patients with clinical N stage, frequent surveillance should be performed.
Identifiants
pubmed: 32356109
doi: 10.1007/s00464-020-07571-y
pii: 10.1007/s00464-020-07571-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1766-1776Commentaires et corrections
Type : ErratumIn
Références
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424
doi: 10.3322/caac.21492
Arnold M, Laversanne M, Brown LM, Devesa SS, Bray F (2017) Predicting the future burden of esophageal cancer by histological subtype: international trends in incidence up to 2030. Am J Gastroenterol 112:1247–1255
doi: 10.1038/ajg.2017.155
Kato H, Sato A, Fukuda H, Kagami Y, Udagawa H, Togo A, Ando N, Tanaka O, Shinoda M, Yamana H, Ishikura S (2009) A phase II trial of chemoradiotherapy for stage I esophageal squamous cell carcinoma: Japan Clinical Oncology Group Study (JCOG9708). Jpn J Clin Oncol 39:638–643
doi: 10.1093/jjco/hyp069
Kato K, Muro K, Minashi K, Ohtsu A, Ishikura S, Boku N, Takiuchi H, Komatsu Y, Miyata Y, Fukuda H (2011) 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 81:684–690
doi: 10.1016/j.ijrobp.2010.06.033
Kumagai K, Mariosa D, Tsai JA, Nilsson M, Ye W, Lundell L, Rouvelas I (2016) Systematic review and meta-analysis on the significance of salvage esophagectomy for persistent or recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy. Dis Esophagus 29:734–739
doi: 10.1111/dote.12399
Faiz Z, Dijksterhuis WPM, Burgerhof JGM, Muijs CT, Mul VEM, Wijnhoven BPL, Smit JK, Plukker JTM (2019) A meta-analysis on salvage surgery as a potentially curative procedure in patients with isolated local recurrent or persistent esophageal cancer after chemoradiotherapy. Eur J Surg Oncol 45:931–940
doi: 10.1016/j.ejso.2018.11.002
Tachimori Y, Kanamori N, Uemura N, Hokamura N, Igaki H, Kato H (2009) Salvage esophagectomy after high-dose chemoradiotherapy for esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg 137:49–54
doi: 10.1016/j.jtcvs.2008.05.016
Hatogai K, Yano T, Kojima T, Onozawa M, Fujii S, Daiko H, Yoda Y, Hombu T, Doi T, Kaneko K, Ohtsu A (2016) Local efficacy and survival outcome of salvage endoscopic therapy for local recurrent lesions after definitive chemoradiotherapy for esophageal cancer. Radiat Oncol (London, England) 11:31
doi: 10.1186/s13014-016-0604-z
Japanese Classification of Esophageal Cancer (2017) Japanese Classification of Esophageal Cancer, 11th Edition: part II and III. Esophagus 14:37–65
doi: 10.1007/s10388-016-0556-2
Inoue H, Takeshita K, Hori H, Muraoka Y, Yoneshima H, Endo M (1993) Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest Endosc 39:58–62
doi: 10.1016/S0016-5107(93)70012-7
Tada M, Murakami A, Karita M, Yanai H, Okita K (1993) Endoscopic resection of early gastric cancer. Endoscopy 25:445–450
doi: 10.1055/s-2007-1010365
Kuwabara H, Abe S, Nonaka S, Suzuki H, Yoshinaga S, Oda I, Saito Y (2019) Clinical feasibility of endoscopic submucosal dissection with minimum lateral margin of superficial esophageal squamous cell carcinoma. Endosc Int Open 7:e396–e402
doi: 10.1055/a-0838-5064
Saito Y, Takisawa H, Suzuki H, Takizawa K, Yokoi C, Nonaka S, Matsuda T, Nakanishi Y, Kato K (2008) Endoscopic submucosal dissection of recurrent or residual superficial esophageal cancer after chemoradiotherapy. Gastroint Endosc 67:355–359
doi: 10.1016/j.gie.2007.10.008
Makazu M, Kato K, Takisawa H, Yoshinaga S, Oda I, Saito Y, Mayahara H, Ito Y, Itami J, Hamaguchi T, Yamada Y, Shimada Y (2014) Feasibility of endoscopic mucosal resection as salvage treatment for patients with local failure after definitive chemoradiotherapy for stage IB, II, and III esophageal squamous cell cancer. Dis Esophagus 27:42–49
doi: 10.1111/dote.12037
Nakajo K, Yoda Y, Hori K, Takashima K, Sinmura K, Oono Y, Ikematsu H, Yano T (2018) Technical feasibility of endoscopic submucosal dissection for local failure after chemoradiotherapy or radiotherapy for esophageal squamous cell carcinoma. Gastrointest Endosc 88:637–646
doi: 10.1016/j.gie.2018.06.033
Yano T, Muto M, Hattori S, Minashi K, Onozawa M, Nihei K, Ishikura S, Ohtsu A, Yoshida S (2008) Long-term results of salvage endoscopic mucosal resection in patients with local failure after definitive chemoradiotherapy for esophageal squamous cell carcinoma. Endoscopy 40:717–721
doi: 10.1055/s-2008-1077480
Ishihara R, Iishi H, Uedo N, Takeuchi Y, Yamamoto S, Yamada T, Masuda E, Higashino K, Kato M, Narahara H, Tatsuta M (2008) Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan. Gastrointest Endosc 68:1066–1072
doi: 10.1016/j.gie.2008.03.1114
Kagawa T, Ishikawa S, Inaba T, Colvin M, Toyosawa J, Aoyama Y, Ishida M, Kuraoka S, Okamoto K, Sakakihara I, Izumikawa K, Yamamoto K, Takahashi S, Tanaka S, Matsuura M, Hasui T, Wato M, Ando M, Nakamura S, Mizobuchi K (2018) Clinicopathological examination of ESD as salvage therapy for esophageal cancer after definitive chemo-radiation therapy. Endosc Int Open 6:E450–e461
doi: 10.1055/s-0044-102296
Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, Repici A, Vieth M, De Ceglie A, Amato A, Berr F, Bhandari P, Bialek A, Conio M, Haringsma J, Langner C, Meisner S, Messmann H, Morino M, Neuhaus H, Piessevaux H, Rugge M, Saunders BP, Robaszkiewicz M, Seewald S, Kashin S, Dumonceau JM, Hassan C, Deprez PH (2015) Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 47:829–854
doi: 10.1055/s-0034-1392882
Koizumi S, Jin M, Matsuhashi T, Tawaraya S, Watanabe N, Sawaguchi M, Kanazawa N, Yamada Y, Onochi K, Kimura Y, Ohba R, Kataoka J, Hatakeyma N, Mashima H, Ohnishi H (2014) Salvage endoscopic submucosal dissection for the esophagus-localized recurrence of esophageal squamous cell cancer after definitive chemoradiotherapy. Gastrointest Endosc 79:348–353
doi: 10.1016/j.gie.2013.09.012
Ishii N, Suzuki K, Fujita Y (2011) Salvage endoscopic submucosal dissection for recurrent esophageal squamous-cell carcinoma after definitive chemoradiotherapy. Clin J Gastroenterol 4:85–88
doi: 10.1007/s12328-011-0203-3
Hattori S, Muto M, Ohtsu A, Boku N, Manabe T, Doi T, Ishikura S, Yoshida S (2003) EMR as salvage treatment for patients with locoregional failure of definitive chemoradiotherapy for esophageal cancer. Gastrointest Endosc 58:65–70
doi: 10.1067/mge.2003.306
Kondo S, Tajika M, Tanaka T, Kodaira T, Mizuno N, Hara K, Hijioka S, Imaoka H, Goto H, Yamao K, Niwa Y (2016) Prognostic factors for salvage endoscopic resection for esophageal squamous cell carcinoma after chemoradiotherapy or radiotherapy alone. Endosc Int Open 4:E841–848
doi: 10.1055/s-0042-109609
Hombu T, Yano T, Hatogai K, Kojima T, Kadota T, Onozawa M, Yoda Y, Hori K, Oono Y, Ikematsu H, Fujii S (2018) Salvage endoscopic resection (ER) after chemoradiotherapy for esophageal squamous cell carcinoma: what are the risk factors for recurrence after salvage ER? Dig Endosc 30:338–346
doi: 10.1111/den.12984
Yano T, Muto M, Minashi K, Onozawa M, Nihei K, Ishikura S, Kaneko K, Ohtsu A (2011) Long-term results of salvage photodynamic therapy for patients with local failure after chemoradiotherapy for esophageal squamous cell carcinoma. Endoscopy 43:657–663
doi: 10.1055/s-0030-1256373